{"doi":"10.34067/kid.0001082019","title":"Short-Term Immunopathological Changes Associated with Pulse Steroids/IVIG/Rituximab Therapy in Late Kidney Allograft Antibody Mediated Rejection","abstract":"Background B cell depletion is a common treatment of antibody-mediated rejection (ABMR). We sought to determine the specific immunopathologic effects of this therapeutic approach in kidney transplantation. Methods This was a prospective observational study of recipients of kidney transplants diagnosed with late ABMR (>3 months after transplant). Patients received treatment with pulse steroids, IVIG, and rituximab. Donor-specific HLA antibodies (DSA), kidney allograft pathology, renal function, immune cell phenotypes, and 47 circulating cytokines were assessed at baseline and at 3 months. Results We enrolled 23 patients in this study between April 2015 and March 2019. The majority of patients were male (74%) and white (78%) with an average age of 45.6±13.8 years. ABMR was diagnosed at 6.8±5.9 years (4 months to 25 years) post-transplant. Treatment was associated with a significant decline in circulating HLA class I ( P =0.003) and class II DSA ( P= 0.002) and peritubular capillaritis (ptc; P= 0.04) compared to baseline. Serum creatinine, BUN, eGFR, and proteinuria (UPC) remained stable. Circulating B cells were depleted to barely detectable levels ( P ≤0.001), whereas BAFF ( P =0.0001), APRIL ( P <0.001), and IL-10 ( P =0.02) levels increased significantly post-treatment. Notably, there was a significant rise in circulating CD4+ ( P= 0.02) and CD8+ T cells ( P= 0.003). We also noted a significant correlation between circulating cytotoxic CD8+ T cells and BAFF ( P =0.05), regulatory T cells and IL-10 ( P =0.002), and regulatory T cells and HLA class I DSA ( P =0.005). Conclusions Short-term pulse steroids/IVIG/rituximab therapy was associated with inhibition of ABMR (DSA and ptc), stabilization of kidney function, and increased regulatory B cell and T cell survival cytokines. Additional studies are needed to understand the implications of B cell depletion on the crosstalk between T cells and B cells, and humoral components that regulate ABMR.","journal":"Kidney360","year":2020,"id":89818,"datarank":0.32958368660043297,"base_score":2.1972245773362196,"endowment":2.1972245773362196,"self_citation_contribution":0.32958368660043297,"citation_network_contribution":0.0,"self_endowment_contribution":0.32958368660043297,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":8,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9461,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2020-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":361349,"name":"Nancy A. Wilson","orcid":"0000-0002-9472-6026","position":1,"is_corresponding":false},{"id":390546,"name":"Shannon R. Reese","orcid":"0000-0002-6760-8876","position":2,"is_corresponding":false},{"id":270996,"name":"Sandesh Parajuli","orcid":"0000-0003-1667-7465","position":3,"is_corresponding":false},{"id":453425,"name":"Fahad Aziz","orcid":"0000-0001-8230-3889","position":4,"is_corresponding":false},{"id":453426,"name":"Neetika Garg","orcid":"0000-0002-7001-2168","position":5,"is_corresponding":false},{"id":453427,"name":"Maha Mohamed","orcid":"0000-0002-7517-8407","position":6,"is_corresponding":false},{"id":453428,"name":"Tripti Singh","orcid":"0000-0002-8855-3421","position":7,"is_corresponding":false},{"id":320239,"name":"Didier A. Mandelbrot","orcid":"0000-0003-3326-8583","position":8,"is_corresponding":false},{"id":390545,"name":"Sarah E. Panzer","orcid":"0000-0002-2565-3134","position":9,"is_corresponding":false},{"id":316715,"name":"Robert R. Redfield","orcid":"0000-0001-5986-3466","position":10,"is_corresponding":false},{"id":454182,"name":"Kristin Van Hyfte","orcid":null,"position":11,"is_corresponding":false},{"id":255408,"name":"Weixiong Zhong","orcid":"0000-0002-4937-1764","position":12,"is_corresponding":false},{"id":453429,"name":"Luis Hidalgo","orcid":"0000-0002-9959-0658","position":13,"is_corresponding":false},{"id":390548,"name":"Arjang Djamali","orcid":"0000-0001-7675-6128","position":14,"is_corresponding":false},{"id":454181,"name":"Kenna R. Degner","orcid":null,"position":0,"is_corresponding":true}],"reference_count":58,"raw_metadata":{"citation_network_status":"fetched"},"created_at":"2026-07-18T22:02:27.195966Z","pmid":"34476406","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}