title: The influence of non-HLA antibodies directed against angiotensin II type 1 receptor (AT1R) on early renal transplant outcomes.
abstract: Non-HLA antibodies (Abs) targeting vascular receptors are thought to have an impact on renal transplant injury. Anti-angiotensin II type 1-receptor-activating antibodies (anti-AT1R) have been mentioned to stimulate a severe vascular rejection, but the pretransplant screening has not been introduced yet. The aim of our study was to assess the incidence and importance of anti-AT1R antibodies and their influence on renal transplant in the 1st year of observation. We prospectively evaluated the presence of anti-AT1R antibodies in 117 consecutive renal transplant recipients in pre- and post-transplant screening. Anti-AT1R antibodies were observed in 27/117 (23%) of the analyzed recipients already before transplantation. The function of renal transplant was considerably worse in anti-AT1R(+) group. The patients with anti-AT1R Abs >9 U/ml lost their graft more often. Biopsy-proven AR was described in 4/27 (15%) pts in the anti-AT1R(+) group and 13/90 (14.4%) in the anti-AT1R(-) group, but more severe cases of Banff IIB or antibody-mediated rejection (AMR) were more often observed in anti-AT1R (+) 4/27 (15%) vs. 1/90 (1.1%) in anti-AT1R(+) (P = 0.009). Patients with anti-AT1R Abs level >9 U/ml run a higher risk of graft failure independently of classical immunological risk factors. The recipients with anti-AT1R Abs developed more severe acute rejections described as IIB or AMR in Banff classification. More recipients among the anti-AT1R-positive ones lost the graft. Our study suggests monitoring of anti-AT1R Abs before renal transplantation for assessment of immunologic risk profiles and the identification of patients highly susceptible to immunologic events, graft failure, and graft loss.
authors.affiliation: Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wroclaw, Poland.
authors.forename: Mirosław
authors.initials: M
authors.lastname: Banasik
authors.forename: Maria
authors.initials: M
authors.lastname: Boratyńska
authors.forename: Katarzyna
authors.initials: K
authors.lastname: Kościelska-Kasprzak
authors.forename: Dorota
authors.initials: D
authors.lastname: Kamińska
authors.forename: Dorota
authors.initials: D
authors.lastname: Bartoszek
authors.forename: Marcelina
authors.initials: M
authors.lastname: Zabińska
authors.forename: Marta
authors.initials: M
authors.lastname: Myszka
authors.forename: Sławomir
authors.initials: S
authors.lastname: Zmonarski
authors.forename: Marcin
authors.initials: M
authors.lastname: Protasiewicz
authors.forename: Beata
authors.initials: B
authors.lastname: Nowakowska
authors.forename: Agnieszka
authors.initials: A
authors.lastname: Hałoń
authors.forename: Pawel
authors.initials: P
authors.lastname: Chudoba
authors.forename: Marian
authors.initials: M
authors.lastname: Klinger
mesh_terms: D000328:Adult; D001323:Autoantibodies / Q000276:immunology* / Q000378:metabolism; D015415:Biomarkers / Q000032:analysis; D015331:Cohort Studies; D016001:Confidence Intervals; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006084:Graft Rejection / Q000276:immunology*; D006680:HLA Antigens / Q000276:immunology* / Q000378:metabolism; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011300:Preoperative Care / Q000379:methods; D011446:Prospective Studies; D044140:Receptor, Angiotensin, Type 1 / Q000276:immunology* / Q000378:metabolism; D012680:Sensitivity and Specificity; D014181:Transplantation Immunology / Q000276:immunology
chemical_list: D001323:Autoantibodies; D015415:Biomarkers; D006680:HLA Antigens; D044140:Receptor, Angiotensin, Type 1
keywords: angiotensin II type 1 receptor antibodies; antibody-mediated rejection; humoral rejection; non-HLA antibodies; renal transplant injury; renal transplantation