Natural Antibodies and Alloreactive T Cells Long after Kidney Transplantation

Background The relationship between circulating effector memory T and B cells long after transplantation and their susceptibility to immunosuppression are unknown. To investigate the impact of antirejection therapy on T cell-B cell coordinated immune responses, we assessed IFN- γ -producing memory cells and natural antibodies (nAbs) that potentially bind to autoantigens on the graft.Methods Plasma levels of IgG nAbs to malondialdehyde (MDA) were measured in 145 kidney transplant recipients at 5–7 years after transplantation. In 54 of these patients, the number of donor-reactive IFN- γ -producing cells was determined. 35/145 patients experienced rejection, 18 of which occurred within 1 year after transplantation.Results The number of donor-reactive IFN- γ -producing cells and the levels of nAbs were comparable between rejectors and nonrejectors. The nAbs levels were positively correlated with the number of donor-reactive IFN- γ -producing cells ( r s  = 0.39, p =0.004). The positive correlation was only observed in rejectors ( r s  = 0.53, p =0.003; nonrejectors: r s  = 0.24, p =0.23). Moreover, we observed that intravenous immune globulin treatment affected the level of nAbs and this effect was found in patients who experienced a late ca-ABMR compared to nonrejectors ( p =0.008).Conclusion The positive correlation found between alloreactive T cells and nAbs in rejectors suggests an intricate role for both components of the immune response in the rejection process. Treatment with intravenous immune globulin impacted nAbs.