The clinicopathological relevance of pretransplant anti-angiotensin II type 1 receptor antibodies in renal transplantation.

Juhan Lee; Kyu Ha Huh; Yongjung Park; Park, Borae G.; Jaeseok Yang; Jong Cheol Jeong; Joongyup Lee; Jae Berm Park; Jang-Hee Cho; Sik Lee; Han Ro; Seung-Yeup Han; Myoung Soo Kim; Yu Seun Kim; Sung Joo Kim; Chan-Duck Kim; Wookyung Chung; Sung-Bae Park; Curie Ahn

Background: Anti-angiotensin II type 1 receptor antibodies (AT1R-Abs) have been suggested as a risk factor for graft failure and acute rejection (AR). However, the prevalence and clinical significance of pretransplant AT1R-Abs have seldom been evaluated in Asia. Methods: In this multicenter, observational cohort study, we tested the AT1R-Abs in pretransplant serum samples obtained from 166 kidney transplant recipients. Statistical analysis was used to set a threshold AT1R-Abs level at 9.05 U/mL. Results: Pretransplant AT1R-Abs were detected in 98/166 (59.0%) of the analyzed recipients. No graft loss or patient death was reported during the study period. AT1R-Abs (+) patients had a significantly higher incidence of biopsy-proven AR than AT1R-Abs (-) patients (27.6 versus 10.3%, P = 0.007). Recipients with pretransplant AT1R-Abs had a 3.2-fold higher risk of AR within a year of transplantation (P = 0.006). Five study subjects developed microcirculation inflammation (score ≥2). Four of them were presensitized to AT1R-Abs. In particular, three patients had a high titer of anti-AT1R-Abs (>22.7 U/mL). Conclusions: Pretransplant AT1R-Abs is an independent risk factor for AR, especially acute cellular rejection, and is possibly associated with the risk of antibody-mediated injury. Pretransplant assessment of AT1R-Abs may be useful for stratifying immunologic risks.

IMMUNOGLOBULINS; BLOOD proteins; ANGIOTENSINS; ANGIOTENSIN II; RENIN-angiotensin system

Nephrology Dialysis Transplantation, 2017, Vol 32, Issue 7, p1244

0931-0509

Academic Journal

10.1093/ndt/gfv375