title: The clinicopathological relevance of pretransplant anti-angiotensin II type 1 receptor antibodies in renal transplantation.
abstract: 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.
authors.affiliation: Department of Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: Juhan
authors.initials: J
authors.lastname: Lee
authors.affiliation: Department of Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: Kyu Ha
authors.initials: KH
authors.lastname: Huh
authors.affiliation: Department of Laboratory Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.|Department of Laboratory Medicine, NHIC Medical Center, Ilsan Hospital, Goyang, Republic of Korea.
authors.forename: Yongjung
authors.initials: Y
authors.lastname: Park
authors.affiliation: Department of Laboratory Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: Borae G
authors.initials: BG
authors.lastname: Park
authors.affiliation: Transplantation Center, Seoul National University Hospital, Seoul, Republic of Korea.
authors.forename: Jaeseok
authors.initials: J
authors.lastname: Yang
authors.affiliation: Transplantation Center, Seoul National University Hospital, Seoul, Republic of Korea.
authors.forename: Jong Cheol
authors.initials: JC
authors.lastname: Jeong
authors.affiliation: Medical Research Collaborating Center, Seoul National University Hospital, Seoul, Republic of Korea.
authors.forename: Joongyup
authors.initials: J
authors.lastname: Lee
authors.affiliation: Department of Surgery, Sungkyunkwan University, Seoul Samsung Medical Center, Seoul, Republic of Korea.
authors.forename: Jae Berm
authors.initials: JB
authors.lastname: Park
authors.affiliation: Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Republic of Korea.
authors.forename: Jang-Hee
authors.initials: JH
authors.lastname: Cho
authors.affiliation: Department of Internal Medicine, Chonbuk National University Hospital, Jeonju, Republic of Korea.
authors.forename: Sik
authors.initials: S
authors.lastname: Lee
authors.affiliation: Department of Internal Medicine, Gachon University, Gil Hospital, Incheon, Republic of Korea.
authors.forename: Han
authors.initials: H
authors.lastname: Ro
authors.affiliation: Department of Internal Medicine, Keimyung University, Dongsan Medical Center, Daegu, Republic of Korea.
authors.forename: Seung-Yeup
authors.initials: SY
authors.lastname: Han
authors.affiliation: Department of Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: Myoung Soo
authors.initials: MS
authors.lastname: Kim
authors.affiliation: Department of Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: Yu Seun
authors.initials: YS
authors.lastname: Kim
authors.affiliation: Department of Surgery, Sungkyunkwan University, Seoul Samsung Medical Center, Seoul, Republic of Korea.
authors.forename: Sung Joo
authors.initials: SJ
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Republic of Korea.
authors.forename: Chan-Duck
authors.initials: CD
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Gachon University, Gil Hospital, Incheon, Republic of Korea.
authors.forename: Wookyung
authors.initials: W
authors.lastname: Chung
authors.affiliation: Department of Internal Medicine, Keimyung University, Dongsan Medical Center, Daegu, Republic of Korea.
authors.forename: Sung-Bae
authors.initials: SB
authors.lastname: Park
authors.affiliation: Transplantation Center, Seoul National University Hospital, Seoul, Republic of Korea.|Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.
authors.forename: Curie
authors.initials: C
authors.lastname: Ahn
mesh_terms: D000328:Adult; D015331:Cohort Studies; D005260:Female; D006084:Graft Rejection / Q000097:blood / Q000175:diagnosis* / Q000209:etiology; D006801:Humans; D007518:Isoantibodies / Q000097:blood* / Q000276:immunology; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D044140:Receptor, Angiotensin, Type 1 / Q000276:immunology*; D012307:Risk Factors
chemical_list: D007518:Isoantibodies; D044140:Receptor, Angiotensin, Type 1
keywords: acute rejection; angiotensin II type 1 receptor antibody; antibody-mediated injury; pretransplant; renal transplantation