Background: Rituximab has been suggested to deplete B cells and decrease the possibility of antibody mediated rejection (AMR) in ABO-incompatible living kidney transplantation (ABO-ILKT). We investigated the relationship between the CD19+ cell ratio among B cells and the incidence of AMR to evaluate the potential of CD19+ cells before transplantation as a predictive marker of AMR.

Method: The CD19+ cell ratio was determined in 225 ABO-ILKT recipients, and related to the incidence of AMR and adverse events within 1 year after transplantation. Independent factors associated with AMR were assessed by univariate and multivariate analysis.

Results: The date of 127 ABO-ILKT recipients were included for analysis. The baseline characteristics of patients that experienced AMR differed significantly from those in the no AMR group with respect to HLA-DR mismatch, donor specific antigen, and CD19+ cells after rituximab.

CD19+ cells ratio (after rituximab before transplantation) was identified as a potential risk factor for AMR. There was a significant difference in the AMR incidence between patients with ≥2% and <2% CD19+ cells; thus, 2% was a determined as a useful cut-off value. Cytomegalovirus viremia was detected in both group, but tends to be more frequent among patients with <2% CD19+ cells; however, the difference was not statistically significant.

Conclusion: This study suggests that the CD19+ cells count before can be a simple marker to predict AMR following ABO-ILKT. Further studies are needed in a larger number of patients and over longer periods of follow-up to confirm the efficacy of this predictive marker.

CITATION INFORMATION: Unagami K., Maenosono R., Furusawa M., Kakuta Y., Okumi M., Ishida H., Tanabe K., Nitta K. CD19+ Cell Ratio as a Predictive Marker of Antibody Mediated Rejection in ABO Incompatible Kidney Transplantation Am J Transplant. 2017;17 (suppl 3).

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