Immune Cell Infiltrate in Chronic-Active Antibody-Mediated Rejection
Kasia A. Sablik, Ekaterina S. Jordanova, Noëlle Pocorni, Marian C. Clahsen‐van Groningen, Michiel G.H. Betjes
Abstract
Background. Little is known about immune cell infiltrate type in the kidney allograft of patients with chronic-active antibody-mediated rejection (c-aABMR). Methods. In this study multiplex immunofluorescent staining was performed on 20 cases of biopsy-proven c-aABMR. T cell subsets (CD3, CD8, Foxp3 and granzyme B), macrophages (CD68 and CD163), B cells (CD20) and NK cells (CD57) were identified and counted in the glomeruli (cells/glomerulus) and the tubulointerstitial (TI) compartment (cells/HPF). Results. In the glomerulus T cells and macrophages were the dominant cell types with a mean 5.5 CD3+ cells/glomerulus and 4 CD68+ cells/glomerulus. The majority of T cells was CD8+ (62%) and most macrophages were CD68+CD163+ (68%). The TI compartment showed a mean of 116 CD3+ cells/HPF, of which 54% were CD8+. Macrophage count was 21.5 cells/HPF with 39% CD68+CD163+. CD20+ cells were sporadically present in glomeruli, whereas B cell aggregates in the TI compartment were frequently observed. NK cells were rarely identified. Remarkably, increased numbers of CD3+FoxP3+ cells in the TI compartment were associated with decreased graft survival (p=0.004). Conclusions. Renal allograft biopsies showing c-aABMR show a predominance of infiltrating CD8+ T cells and increased numbers of interstitial FoxP3+ T cells are associated with inferior allograft survival.