Cryptic B Cell Response to Renal Transplantation

Abstract

Transplantation reliably evokes allo‐specific B cell and T cell responses in mice. Yet, human recipients of kidney transplants with normal function usually exhibit little or no antibody specific for the transplant donor during the early weeks and months after transplantation. Indeed, the absence of antidonor antibodies is taken to reflect effective immunosuppressive therapy and to predict a favorable outcome. Whether the absence of donor‐specific antibodies reflects absence of a B cell response to the donor, tolerance to the donor or immunity masked by binding of donor‐specific antibodies to the graft is not known. To distinguish between these possibilities, we devised a novel ELISPOT, using cultured donor, recipient and third‐party fibroblasts as targets. We enumerated donor‐specific antibody‐secreting cells in the blood of nine renal allograft recipients with normal kidney function before and after transplantation. Although none of the nine subjects had detectable donor‐specific antibodies before or after transplantation, all exhibited increases in the frequency of donor‐specific antibody‐secreting cells eight weeks after transplantation. The responses were directed against the donor HLA‐class I antigens. The increase in frequency of donor‐specific antibody‐secreting cells after renal transplantation indicates that B cells respond specifically to the transplant donor more often than previously thought. The authors report that clinical transplantation evokes an appreciable B cell response in most, if not all, transplant recipients, raising the prospect that accommodation might be a more common outcome than previously thought. See editorial by Clatworthy on page 1629.