Session Name: Concurrent Session: Pathways of Clinical Rejection
Date: Sunday, April 30, 2017
Session Time: 4:30pm-6:00pm
Presentation Time: 4:30pm-4:42pm
In renal transplantation, many allograft recipients develop donor-specific antibodies associated with an increased risk for graft rejection. Current immunosuppressive agents are principally aimed at T-cell-mediated alloimmunity, underestimating humoral effectors. Antibody responses are mainly mediated by BCL6+ T follicular helper (Tfh)-cells that activate B-cells predominantly via interleukin-21 (IL-21). Whether this reaction appears in the allograft is still being debated. Here, we investigated if ectopic lymphoid structures (ELSs) are present in T cell mediated rejection (type I and II) and antibody-mediated rejection after renal transplantation.
Material & Methods
Fifteen renal transplant biopsies were studied. Primary diagnosis were C4d+ antibody-mediated rejection (ABMR, n=5), T-cell mediated rejection type I (TCMRI, n=5), and T-cell mediated rejection type II (TCMRII, n=5). FFPE sections were stained for T-cells (CD3), B-cells (CD20), and follicular dendritic cells (FDCs, CD23). In addition, double immunofluorescent stainings for IL-21 and BCL6 were performed. Slides were analyzed for the presence and composition of infiltrate.
In all 15 biopsies, infiltrates of CD3+ T cells were detected. In TCMRI, CD20+ B-cells formed aggregates surrounded by T-cells in the tubulo-interstitial compartment. In these aggregates CD23+ FDCs were detected, suggesting the presence ELSs. In contrast, ABMR and TCMRII showed diffuse spread of T cells and B cells and no CD23+ cell aggregates. IL-21 was present in all biopsies, however, co-localization with BCL6 was predominantly observed in TCMRI biopsies.
Nodal lymphoid proliferations with FDC networks and BCL6+IL-21+ cells are mainly found in TCMRI and may suggest a pivotal role for Tfh cell – B cell interaction.
CITATION INFORMATION: de Leur K, Clahsen-van Groningen M, de Graav G, Hesselink D, Samsom J, Baan C, Boer K. Ectopic Lymphoid Structures Are Present in Type I T-Cell Mediated Kidney Transplant Rejection. Am J Transplant. 2017;17 (suppl 3).
To cite this abstract in AMA style:Leur Kde, Groningen MClahsen-van, Graav Gde, Hesselink D, Samsom J, Baan C, Boer K. Ectopic Lymphoid Structures Are Present in Type I T-Cell Mediated Kidney Transplant Rejection. [abstract]. Am J Transplant. 2017; 17 (suppl 3). https://atcmeetingabstracts.com/abstract/ectopic-lymphoid-structures-are-present-in-type-i-t-cell-mediated-kidney-transplant-rejection/. Accessed August 3, 2021.
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