Association of CD20+ infiltrates with poorer clinical outcomes in acute cellular rejection of renal allografts

Am J Transplant. 2005 Sep;5(9):2248-52. doi: 10.1111/j.1600-6143.2005.01009.x.


We undertook a study to ascertain the relationship between the presence of CD20-positive B-lymphocytes in renal allografts undergoing acute cellular rejection and graft survival. We identified 27 patients transplanted between January 1, 1998 and December 31, 2001, with biopsy-proven Banff 1-A or Banff 1-B rejection in the first year after transplantation, and stained the specimens for CD20 and C4d. At least 4 years of follow-up data were available for each patient studied. Six patients had CD20-positive B-cell clusters in the interstitium, and 21 patients were negative for CD20 infiltrates. The CD20-positive group was significantly more likely to have steroid-resistant rejection and reduced graft survival compared to CD20-negative controls. This study supports prospective identification of CD20-positive B-cell clusters in biopsy-proven rejection and offers a therapeutic rationale for a trial of monoclonal anti-CD20 antibody in such patients.

MeSH terms

  • Adult
  • Aged
  • Antibodies, Monoclonal / chemistry
  • Antigens, CD20 / biosynthesis*
  • B-Lymphocytes / metabolism
  • Biopsy
  • Complement C4b / biosynthesis
  • Female
  • Follow-Up Studies
  • Graft Rejection*
  • Graft Survival
  • Humans
  • Immunohistochemistry
  • Immunosuppressive Agents / therapeutic use
  • Kidney / metabolism
  • Kidney / pathology
  • Kidney Transplantation / methods*
  • Male
  • Middle Aged
  • Peptide Fragments / biosynthesis
  • Retrospective Studies
  • Time Factors
  • Transplantation, Homologous
  • Treatment Outcome


  • Antibodies, Monoclonal
  • Antigens, CD20
  • Immunosuppressive Agents
  • Peptide Fragments
  • Complement C4b
  • complement C4d