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- Title
Clinical Impact of Pre-transplant Antibodies Against Angiotensin II Type I Receptor and Major Histocompatibility Complex Class I-Related Chain A in Kidney Transplant Patients.
- Authors
Ji Won Min; Hyeyoung Lee; Bum Soon Choi; Cheol Whee Park; Chul Woo Yang; Yong-Soo Kim; Yeong Jin Choi; Eun-Jee Oh; Byung Ha Chung
- Abstract
Background: Evidence of antibody-mediated injury in the absence of donor-specific HLA antibodies (HLA-DSA) has recently emerged, suggesting a role of antibodies in targeting non-HLA antigens expressed on renal allograft tissue. However, the clinical significance of pre-transplant non-HLA antibodies remains unclear. We compared the histological and clinical impact of pre-transplant HLA-DSA and non-HLA antibodies, especially angiotensin II type I receptor (anti-AT1R) and MHC class I-related chain A (anti-MICA), in kidney transplant patients. Methods: Pre-transplant HLA-DSA, anti-AT1R, and anti-MICA were retrospectively examined in 359 kidney transplant patients to determine the effect of each antibody on allograft survival and clinical characteristics. Results: Pre-transplant HLA-DSA, anti-AT1R, and anti-MICA were detected in 37 (10.3%), 174 (48.5%), and 50 patients (13.9%), respectively. Post-transplant antibody-mediated rejection was associated with a pre-transplant HLA-DSA (+) status only. The development of microvascular inflammation (MVI) was associated with pre-transplant HLA-DSA (P =0.001) and anti-AT1R (P =0.036). Anti-AT1R (+) patients had significantly lower allograft survival compared with anti-AT1R (-) patients (P =0.042). Only pre-transplant anti-AT1R positivity was an independent risk factor for allograft failure (hazard ratio 4.824, confidence interval 1.017-24.888; P =0.038). MVI was the most common histological feature of allograft failure in patients with pre-transplant anti-AT1R. Conclusions: Pre-transplant anti-AT1R is an important risk factor for allograft failure, which may be mediated by MVI induction in the allograft tissue.
- Subjects
KIDNEY transplant patients; ANGIOTENSIN II; ANGIOTENSIN receptors; THERAPEUTIC use of immunoglobulins; MAJOR histocompatibility complex; CLINICAL trials; THERAPEUTICS
- Publication
Annals of Laboratory Medicine, 2018, Vol 38, Issue 5, p450
- ISSN
2234-3806
- Publication type
Article
- DOI
10.3343/alm.2018.38.5.450