Circulating anti-endothelial cell antibodies are associated with poor outcome in renal allograft recipients with acute rejection.
OBJECTIVE
Anti-endothelial cell antibody (AECA) can cause hyperacute rejection and immediate graft loss after renal transplantation; however, its prevalence and significance during acute rejection are unknown. Previous studies suggested that AECA may be detected in recipients with acute vascular rejection (AVR).


METHODS
We retrospectively analyzed 653 cadaveric renal transplant recipients; circulating AECA was positive in 13 of 47 cases of AVR; another two cases of hyperacute rejection also had detectable AECA. Twenty-six cases of AVR without circulating AECA were selected as controls.


RESULTS
AECA-positive AVR usually occurred within 1 yr after transplantation and mostly was resistant to steroid treatment. Compared with the control group, the AECA-positive group was associated with a significantly lower 1-yr graft survival rate (46.7 versus 80.5%; P = 0.038), and more patients had histologic interstitial plasma cell infiltration (53.8 versus 11.5%; P = 0.005). More patients with AECA-positive AVR experienced another one or more episodes of acute rejection during 1 yr of follow-up (75.0 versus 13.0%; P = 0.003). AECA-positive AVR with C4d deposition in peri-tubular capillaries had the worst outcome in this cohort, and it accounted for 38.5% graft loss in AVR. AECA in turn accounted for 71.4% of graft loss in C4d(+) AVR.


CONCLUSIONS
Circulating AECA is associated with poor outcome in renal allograft recipients with acute rejection and should be monitored regularly.
Sun
Qiquan
Q
Research Institute of Nephrology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China. sunqiquan@hotmail.com
Liu
Zhihong
Z
Chen
Jinsong
J
Chen
Huiping
H
Wen
Jiqiu
J
Cheng
Dongrui
D
Li
Leishi
L
D000208:Acute Disease; D000328:Adult; D001323:Autoantibodies / Q000097:blood*; D002102:Cadaver; D002196:Capillaries / Q000276:immunology; D015935:Complement C4b / Q000032:analysis; D042783:Endothelial Cells / Q000276:immunology* / Q000473:pathology; D005260:Female; D006084:Graft Rejection / Q000276:immunology* / Q000401:mortality / Q000473:pathology / Q000628:therapy; D006085:Graft Survival / Q000276:immunology*; D006680:HLA Antigens / Q000276:immunology; D006801:Humans; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D010446:Peptide Fragments / Q000032:analysis; D012189:Retrospective Studies; D013997:Time Factors; D014184:Transplantation, Homologous; D016896:Treatment Outcome
D001323:Autoantibodies; D006680:HLA Antigens; D010446:Peptide Fragments; C087589:anti-endothelial cell antibody; D015935:Complement C4b; C032261:complement C4d