title: Pre-transplant angiotensin II type 1 receptor antibodies: A risk factor for decreased kidney graft function in the early post-transplant period?
abstract: Angiotensin II type 1 receptor antibodies (AT,Rab) are associated with a significantly lower graft survival and a higher risk of acute rejection after kidney transplantation. This study aimed to evaluate graft function and biopsy proven acute rejection (BPAR) during the first year post-transplant in adult renal transplant recipients (RTR), between 03/2009 and 08/2012. Pre-transplant sera were screened for AT1Rab (via enzyme linked immunosorbent assay) and donor specific anti-human leukocyte antigen antibodies (HLA-DSA, via Luminex). Three groups were analyzed: AT1Rab only (n=13); HLA-DSA only (n=8); and no AT1Rab or HLA-DSA (n=90). No differences were observed in clinical characteristics across groups. A higher percentage of BPAR was observed in the AT1Rab positive group, but this difference was not significant. RTR with AT1Rab had a lower median estimated glomerular filtration rate (eGFR=20 ml/min/1.73m2) when compared to RTR with no antibodies at 12 months. A significant difference in eGFR was observed since the first month post-transplant. Multivariate analysis showed four factors independently and significantly associated with eGFR at 12 months post-transplant: BPAR (beta -18.7, 95% CI -28.2 to -9.26, p<0.001), AT,Rab (beta -10.51, 95% CI -20.9 to -0.095 p=0.048), donor age (beta -0.42, 95% CI -0.75 to -0.103, p=0.010), and recipient age (3 -0.36, 95% CI -0.67 to -0.048, p= 0.024). In this study, AT1Rab in pre-transplant sera from RTR was an independent and significant risk factor contributing to a lower eGFR at 12 months posttransplant. This finding deserves to be confirmed in a larger RTR population.
authors.forename: Erick Alejandro
authors.initials: EA
authors.lastname: Hernández-Méndez
authors.forename: José Manuel
authors.initials: JM
authors.lastname: Arreola-Guerra
authors.forename: Luis E
authors.initials: LE
authors.lastname: Morales-Buenrostro
authors.forename: Julia B
authors.initials: JB
authors.lastname: Ramírez
authors.forename: Said
authors.initials: S
authors.lastname: Calleja
authors.forename: Natalia
authors.initials: N
authors.lastname: Castelán
authors.forename: Isaac
authors.initials: I
authors.lastname: Salcedo
authors.forename: Mario
authors.initials: M
authors.lastname: Vilatobá
authors.forename: Alan G
authors.initials: AG
authors.lastname: Contreras
authors.forename: Bernardo
authors.initials: B
authors.lastname: Gabilondo
authors.forename: Julio
authors.initials: J
authors.lastname: Granados
authors.forename: Josefina
authors.initials: J
authors.lastname: Alberú
mesh_terms: D000328:Adult; D001323:Autoantibodies / Q000097:blood / Q000276:immunology*; D051799:Delayed Graft Function / Q000453:epidemiology* / Q000276:immunology*; D005260:Female; D006084:Graft Rejection / Q000453:epidemiology / Q000276:immunology; D006801:Humans; D016030:Kidney Transplantation / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D011237:Predictive Value of Tests; D057234:Preoperative Period; D044140:Receptor, Angiotensin, Type 1 / Q000276:immunology*; D012189:Retrospective Studies; D012307:Risk Factors; D016036:Seroepidemiologic Studies; D055815:Young Adult
chemical_list: D001323:Autoantibodies; D044140:Receptor, Angiotensin, Type 1