ATC Abstracts

American Transplant Congress abstracts

  • Home
  • Meetings Archive
    • 2022 American Transplant Congress
    • 2021 American Transplant Congress
    • 2020 American Transplant Congress
    • 2019 American Transplant Congress
    • 2018 American Transplant Congress
    • 2017 American Transplant Congress
    • 2016 American Transplant Congress
    • 2015 American Transplant Congress
    • 2013 American Transplant Congress
  • Keyword Index
  • Resources
    • 2021 Resources
    • 2016 Resources
      • 2016 Welcome Letter
      • ATC 2016 Program Planning Committees
      • ASTS Council 2015-2016
      • AST Board of Directors 2015-2016
    • 2015 Resources
      • 2015 Welcome Letter
      • ATC 2015 Program Planning Committees
      • ASTS Council 2014-2015
      • AST Board of Directors 2014-2015
      • 2015 Conference Schedule
  • Search

Longitudinal Characterization of Memory B Cells During Antibody Mediated Rejection Treated with Plasmapheresis, Bortezomib, and Belatacept in Heart Transplant Recipients

F. Alkhunaizi1, M. Ellison2, V. Berrich1, M. Siegelin1, M. Szabolcs1, G. F. Sayer1, N. Uriel1, S. Restaino1, A. Chong3, A. Zeevi2, M. Habal1

1Columbia University Medical Center, New York, NY, 2University of Pittsburgh Medical Center, Pittsburgh, PA, 3University of Chicago, Chicago, IL

Meeting: 2022 American Transplant Congress

Abstract number: 241

Keywords: Alloantibodies, B cells, Co-stimulation, Immunosuppression

Topic: Clinical Science » Heart » 63 - Heart and VADs: All Topics

Session Information

Session Name: Heart and VADs: All Topics II

Session Type: Rapid Fire Oral Abstract

Date: Monday, June 6, 2022

Session Time: 3:30pm-5:00pm

 Presentation Time: 4:40pm-4:50pm

Location: Hynes Room 210

*Purpose: Donor specific antibodies (DSA) and antibody mediated rejection (AMR) continue to limit allograft longevity after heart transplant. Effective treatments are limited and often complicated by rebound.

*Methods: We characterized the circulating memory B cell (Bmem) phenotype (CyTOF), DSA (titer, IgG subclass) and biopsy findings during AMR in two heart transplant recipients and prospectively followed the response to treatment with corticosteroids (CS), plasmapheresis (PP), bortezomib (BTZ), and belatacept (BEL). A recipient with HLA antibodies (H1), where BEL was added to standard of care immunosuppression (SOC), was used for comparison.

*Results: Case 1 (C1) presented with acute on chronic AMR and had a sustained response to treatment (mild persistent chronic AMR). Case 2 (C2) developed acute AMR during post-rituximab peripheral B cell reconstitution, initially responded, then rebounded. Retreatment led to a significant reduction in DSA (p=0.05) and complete biopsy resolution (grade 0). Monthly BEL was continued in both cases. We analyzed B cell subsets (Fig 1B) noting a sustained reduction in switched CD27+IgD– B cells (SwBmem) in C1 (10.5 to 5.0%), a rapid increase prior to recurrent AMR in C2 (7.3 to 18.2%), and no change in H1 (12.3 to 11.9%). SwBmem during AMR clustered distinctly from quiescence (H1) with higher frequencies of CD27++CD38++ antibody secreting cells (ASCs) and activated Bmem (CD27+CD38-/loCD21-/lo CD11chiCD95hi). Transient robust ASC expansion occurred 6 weeks prior to recurrent AMR (C2) which diminished before retreatment with CS/PP/BTZ. IgD–CD27-/lo B cells before recurrence were enriched for a CD38+CD95+Ki67+ phenotype. At the time of histological recurrence while on BEL/SOC, Ki67+ B cells, ASCs, and activated Bmem were suppressed.

*Conclusions: Our preliminary characterization of circulating Bmem during AMR suggests features common to those described in kidney transplantation including increased frequencies of ASCs and activated Bmem. Treatment combining CS/PP/BTZ with BEL/SOC reduced DSA, ASCs, and activated Bmem. Rapid but transient B cell proliferation with distinct characteristics preceded recurrent AMR. Additional cases are being prospectively studied and will be compared to patients undergoing desensitization with a similar protocol.

  • Tweet
  • Email
  • Print

To cite this abstract in AMA style:

Alkhunaizi F, Ellison M, Berrich V, Siegelin M, Szabolcs M, Sayer GF, Uriel N, Restaino S, Chong A, Zeevi A, Habal M. Longitudinal Characterization of Memory B Cells During Antibody Mediated Rejection Treated with Plasmapheresis, Bortezomib, and Belatacept in Heart Transplant Recipients [abstract]. Am J Transplant. 2022; 22 (suppl 3). https://atcmeetingabstracts.com/abstract/longitudinal-characterization-of-memory-b-cells-during-antibody-mediated-rejection-treated-with-plasmapheresis-bortezomib-and-belatacept-in-heart-transplant-recipients/. Accessed May 9, 2025.

« Back to 2022 American Transplant Congress

Visit Our Partner Sites

American Transplant Congress (ATC)

Visit the official site for the American Transplant Congress »

American Journal of Transplantation

The official publication for the American Society of Transplantation (AST) and the American Society of Transplant Surgeons (ASTS) »

American Society of Transplantation (AST)

An organization of more than 3000 professionals dedicated to advancing the field of transplantation. »

American Society of Transplant Surgeons (ASTS)

The society represents approximately 1,800 professionals dedicated to excellence in transplantation surgery. »

Copyright © 2013-2025 by American Society of Transplantation and the American Society of Transplant Surgeons. All rights reserved.

Privacy Policy | Terms of Use | Cookie Preferences