Decreased total CD19⁺ B lymphocytes and the occurrence of monoclonal proteins are frequent in ultra-long (30 to 44-year) renal transplant recipients: implications for allograft and patient survival.

Background: The B-cell signature of tolerance in kidney transplant patients receiving no immunosuppression includes a significant increase in total CD19(+) B cells.

Methods: We evaluated kidney transplant recipients with primary functioning allografts for 30-44 years receiving minimal immunosuppression to determine whether they have the same CD19(+) B-cell changes or unusual serologic findings. We included 44 kidney allograft recipients with a graft functioning for 30-44 years, who were treated primarily with minimal prednisone and azathioprine.

Ultra-late antibody-mediated rejection 30 years after a living-related renal allograft.

Antibody-mediated renal allograft rejection has become increasingly recognized and more clearly defined through the use of flow cytometry cross-matching and the deposition of C4d in renal allograft biopsies. All of the cases reported thus far have developed an antibody within 10 years of transplantation, and many lacked HLA and/or donor specificity. The present patient developed an anti-HLA donor-specific antibody between the 22nd and 30th year after a living-related renal transplant.