Pathophysiological role of B cells and the therapeutic potential of anti-CD20 in chronic renal allograft rejection

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50% of the patients who receive a kidney transplant (or ‘graft‘) will have to return dialysis within 10 years. One group at high risk are those who develop antibodies. To help prolong the grafts in these patients, this project aims to clarify precisely how antibodies are associated with graft damage. Approximately 60 patients with antibodies from within 300 transplant recipients will be identified. Further analysis will depend on whether their grafts are deteriorating. If so, blood and biopsy specimens will be examined to try and identify whether (and how) antibody is involved in the process of deterioration. All these patients will be offered treatment to stop their ‘B‘ lymphocytes (the cells that makes antibodies) from working, to see if this it affects the rate of graft deterioration. This therapy works well in other antibody-associated conditions and is generally safe to use. A small number of patients with antibodies are expected to have grafts that are working well. These patients will be studied to try and understand why antibodies or T cells do not damage their grafts. It is expected that this work will help understanding of the mechanisms of graft loss and should improve the prognosis of patients with failing transplants.