ASN's Mission

To create a world without kidney diseases, the ASN Alliance for Kidney Health elevates care by educating and informing, driving breakthroughs and innovation, and advocating for policies that create transformative changes in kidney medicine throughout the world.

learn more

Contact ASN

1401 H St, NW, Ste 900, Washington, DC 20005


The Latest on Twitter

Kidney Week

Abstract: FR-OR138

The Effect of Pulse Steroids/IVIG/Rituximab on Circulating Lymphocytes and Cytokines in Kidney Transplant Recipients with Chronic Active ABMR)

Session Information

Category: Transplantation

  • 1802 Transplantation: Clinical


  • Wilson, Nancy A., University of Wisconsin, Madison, Wisconsin, United States
  • Bath, Natalie M., University of Wisconsin, Madison, Wisconsin, United States
  • Panzer, Sarah E., University of Wisconsin Madison, Madison, Wisconsin, United States
  • Djamali, Arjang, School of Medicine and Public Health, Madison, Wisconsin, United States
  • Reese, Shannon, University of Wisconsin, Madison, Wisconsin, United States

There is no information on the effect of combination therapy with pulse steroids/IVIG/Rituximab on circulating T-cell and B-cell phenotypes and cytokines in kidney transplant recipients (KTR) with chronic active antibody mediated rejection (cABMR).


We examined this questions in 8 KTR with cABMR who underwent follow up evaluation with a repeat protocol biopsy within 3 months of the initial diagnosis. PBMC subsets were identified using flow cytometry. Plasma was analyzed using Luminex 45-plex assay for cytokines. Paired Wilcoxon rank sum test was utilized to assess the effect of therapy on pre and post samples. Pre-treatment samples were also compared to a group of 11 healthy volunteers matched for age, gender, and race.


Median age at the diagnosis of cABMR was 48 years. The diagnosis was made at a median of 9.8 years post-transplant. Median Scr and urine PC at biopsy were 2.43 mg/dL and 1.24 g/g. Treatment with pulse steroids/IVIG/Rituximab was associated with a statistically significant decline in ptc and mvi Banff scores (p<0.05) at the three-month protocol biopsy. Similarly, B cells, Naïve B cells, plamablasts, and transitional B cells were significantly reduced (p<0.05 for all). However, treatment was associated with a significant increase in CD3 T cells and IL17 levels (p=0.02 for both). There was no significant difference in other Banff scores, kidney function, and Treg or Breg populations. Compared to controls, KTR had significantly lower naïve B cells, plasmablasts, and transitional B cells, while cirtculating fractaline, IL1-alpha, IL7, IL13, IL15, PDL1, and VEGF levels were significantly increased (p<0.04 for all).


In conclusion, KTR with ABMR have significantly different circulating B cell and cytokine profiles than healthy volunteers. Short term therapy with Pulse steroids/IVIG/Rituximab effectively inhibits disease activity in cABMR. However, treatment is associated with an upregulation of T cell response suggesting a negative feedback role for B cells in cABMR.