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- Title
Pre‐transplant angiotensin II receptor type I antibodies in pediatric renal transplant recipients: An observational cohort study.
- Authors
Pizzo, Helen; Mirocha, James; Choi, Jua; Garrison, Jonathan; Haas, Mark; Zhang, Xiaohai; Kamil, Elaine S.; Kim, Irene; Jordan, Stanley C.; Puliyanda, Dechu P.
- Abstract
Background: The role of angiotensin II type 1 receptor antibodies (AT1R‐Ab) in pediatric renal transplantation is unclear. Here, we evaluated pre‐transplant AT1R‐Ab on transplant outcomes in the first 5 years. Secondary analysis compared pre‐transplant AT1R‐Ab levels by age. Methods: Thirty‐six patients, 2–20 years old, were divided into two groups: pre‐transplant AT1R‐Ab− (<17 U/ml; n = 18) and pre‐transplant AT1R‐Ab+ (≥17 U/ml; n = 18). eGFR was determined at 6‐month, 1‐, 2‐, and 4‐year post‐transplant. Allograft biopsies were performed in the setting of strong HLA‐DSA (MFI > 10 000), AT1R‐Ab ≥17 U/ml, and/or elevated creatinine. Results: Mean age in pre‐transplant AT1R‐Ab− was 13.3 years vs. 11.0 in pre‐transplant AT1R‐Ab+ (p = 0.16). At 6 months, mean eGFR was 111.3 ml/min/1.73 m2 in pre‐transplant AT1R‐Ab− vs. 100.2 in pre‐transplant AT1R‐Ab + at 1 year, 103.6 ml/min/1.73 m2 vs. 100.5; at 2 years, 98.9 ml/min/1.73 m2 vs. and 93.7; at 4 years, 72.6 ml/min/1.73 m2 vs. 80.9. 11/36 patients had acute rejection (6 in pre‐transplant AT1R‐Ab−, 5 in pre‐transplant AT1R‐Ab +). There was no difference in rejection rates. All 6 subjects with de novo HLA‐DSA and AT1R‐Ab ≥17 U/ml at the time of biopsy experienced rejection. Mean age in those with the AT1R‐Ab ≥40 U/ml was 10.0 years vs. 13.2 in those <40 U/ml (p = 0.07). Conclusion: In our small cohort, pre‐transplant AT1R‐Ab ≥17 U/ml was not associated with reduced graft function or rejection. The pathogenicity of pre‐transplant AT1R‐Ab in pediatric kidney transplantation requires further investigation.
- Subjects
ANGIOTENSIN II; ANGIOTENSIN receptors; KIDNEY transplantation; RECEPTOR antibodies; IMMUNOGLOBULINS
- Publication
Pediatric Transplantation, 2022, Vol 26, Issue 8, p1
- ISSN
1397-3142
- Publication type
Article
- DOI
10.1111/petr.14400