Session Name: B-cell / Antibody /Autoimmunity
Session Date & Time: None. Available on demand.
*Purpose: After lung transplantation (LTx), the development of early donor HLA-specific antibodies (eDSA) is associated with antibody-mediated rejection (AMR) and poor graft survival. Since 2013, patients with eDSA within the first month after LTx are treated with IgA/IgM enriched intravenous immunoglobulins (IgGAM), occasionally with anti-CD20 antibody (Rituximab). We hypothesise that the composition of naïve and memory B cell subsets differs between eDSA-positive and negative patients already before and directly after LTx.
*Methods: In a pilot study of 58 LTx recipients, B cell subsets were analysed by flow cytometry using CD19, CD20, IgD, CD24, CD27antibodies pre, post (T0), 24 hours (T24) and 3 weeks after LTx. The proportions of B cell subsets were compared between eDSA-positive (n=13, 22,4%) and -negative (n=45, 77,6%) patients at discharge three weeks after transplantation.
*Results: Within the first 24h, patients without eDSAs showed a significant increase in IgD+ CD27- naïve B cells (p<0,0001) accompanied by a significant decrease in IgD- CD27+ memory B cells, independently of the presence of eDSA (all, p<0,0007). Of note, eDSA-positive patients constantly showed higher frequencies of IgD+CD27–CD24hi naïve and lower frequencies of IgD–CD27–CD24lo memory B cell subsets compared to eDSA-negative patients. A transient increase in IgD+CD27+ switch memory B cells was detected at T0 in both groups, returning to baseline levels already at T24.
*Conclusions: Lung transplant recipients show remarkable dynamics of naïve, memory and switch memory B cells within the first 24 hours characterized by a shift from naïve towards memory B cells, which was more pronounced in the eDSA group. Based on these preliminary data, a refined B cell monitoring may be able to identify patients with a higher risk for eDSA development in the future and pave the way to more specific treatment options to prevent eDSA.
To cite this abstract in AMA style:Christoph S, Hitz A, Sanz RBellmàs, Kühne J, Wiegmann B, Ius F, Salman J, Chichelnitskiy E, Siemeni T, Sommer W, Haverich A, Warnecke G, Falk C. Lung Transplant Recipients Developing Early DSAs are Characterized by a Shift Towards Memory B Cells Directly After Transplantation [abstract]. Am J Transplant. 2021; 21 (suppl 3). https://atcmeetingabstracts.com/abstract/lung-transplant-recipients-developing-early-dsas-are-characterized-by-a-shift-towards-memory-b-cells-directly-after-transplantation/. Accessed September 21, 2021.
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