title: Angiotensin II type 1 receptor antibody precipitating acute vascular rejection in kidney transplantation.
abstract: Atypical non HLA antibodies are increasingly recognised as causes of immunological injury in allotransplantation. In this report we describe a non HLA sensitized male renal allograft recipient who developed acute vascular rejection on a "for cause" biopsy (Banff v2, g2, ptc 3) at day 4 post first renal allograft in the presence of elevated angiotensin II type 1 receptor antibodies (AT1R-Ab level 14.1). The acute rejection was treated with pulse corticosteroid therapy, anti-thymocyte globulin (ATG × 6), plasma exchange (1.5 plasma volume replacement x6) and oral candesartan. Serum creatinine improved and follow up biopsy confirmed resolution of rejection following treatment. AT1R-Ab should be considered when rejection is diagnosed in the absence of HLA antibodies.
authors: Royal Adelaide Hospital, Adelaide, South Australia, Australia.
authors: Anjelo
authors: A
authors: Jobert
authors: Nitesh
authors: N
authors: Rao
authors: Sue
authors: S
authors: Deayton
authors: Greg D
authors: GD
authors: Bennett
authors: John
authors: J
authors: Brealey
authors: James
authors: J
authors: Nolan
authors: Robert P
authors: RP
authors: Carroll
authors: Duska
authors: D
authors: Dragun
authors: Patrick T
authors: PT
authors: Coates
mesh_terms: D000208:Acute Disease; D000284:Administration, Oral; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage; D000328:Adult; D064591:Allografts; D047228:Angiotensin II Type 1 Receptor Blockers / Q000008:administration & dosage; D000961:Antilymphocyte Serum / Q000008:administration & dosage; D001323:Autoantibodies / Q000097:blood*; D001562:Benzimidazoles / Q000008:administration & dosage; D001706:Biopsy; D001713:Biphenyl Compounds; D006084:Graft Rejection / Q000175:diagnosis / Q000276:immunology* / Q000628:therapy; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D010951:Plasma Exchange; D020551:Pulse Therapy, Drug; D044140:Receptor, Angiotensin, Type 1 / Q000187:drug effects / Q000276:immunology*; D012720:Severity of Illness Index; D013777:Tetrazoles / Q000008:administration & dosage; D013997:Time Factors; D016896:Treatment Outcome; D015854:Up-Regulation
chemical_list: C544065:AGTR1 protein, human; D000305:Adrenal Cortex Hormones; D047228:Angiotensin II Type 1 Receptor Blockers; D000961:Antilymphocyte Serum; D001323:Autoantibodies; D001562:Benzimidazoles; D001713:Biphenyl Compounds; D007166:Immunosuppressive Agents; D044140:Receptor, Angiotensin, Type 1; D013777:Tetrazoles; C081643:candesartan
keywords: atypical antibody; non HLA antibodies; rejection; vascular