title: Pretransplant angiotensin II type 1-receptor antibodies are a risk factor for earlier detection of de novo HLA donor-specific antibodies.
abstract: Angiotensin II type 1 receptor antibodies (AT1Rabs) have been associated with significantly reduced graft survival. Earlier graft loss has been observed in patients who had pretransplant AT1Rabs and posttransplant donor-specific antibodies (DSA).
  
  
  
  The main goal of this retrospective cohort study was to examine the association between AT1Rabs and the time period to detection of de novo human leukocyte antigen (HLA-DSA) posttransplantation in living donor kidney transplant recipients (KTR). The analysis included 141 KTRs. Pretransplant frozen serum samples were tested for AT1Rabs by ELISA and HLA-DSA by SAB (Luminex) at both the pre- and post-KT time points.
  
  
  
  The median AT1Rab level was 9.13 U (interquartile range 5.22-14.33). After a mean follow-up period of 3.55 years, 48 patients were found to harbour de novo HLA-DSAs. The presence of AT1Rabs [hazard ratio (HR) 1.009, 95% confidence interval (CI) 1.002-1.01, P = 0.010], male-to-male transplantation (HR 2.57, 95% CI 1.42-4.67, P = 0.002) and antecedent borderline changes or acute cellular rejection (ACR) (HR 2.47, 95% CI 1.29-4.75, P = 0.006) were significantly associated with de novo DSA detection. A dose-dependent association between AT1Rab levels (<10 U, 10.1-16.9 U, 17-29.9 U and >30 U) and de novo DSA detection was observed (log-rank P = 0.0031). After multivariate analysis of AT1Rab levels (continuous variable), AT1Rabs >30 U, male-to-male transplantation, donor age, higher class I percentage of Panel Reactive Antibody and antecedent borderline changes or ACR remained as independent significant risk factors for the detection of de novo DSAs.
  
  
  
  The findings suggest that higher levels of pretransplant circulating antibodies against AT1R (>30 U) in kidney graft recipients constitute an independent risk factor for earlier de novo HLA-DSA detection during the posttransplant period.
authors.affiliation: Department of Transplantation, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México, Mexico.
authors.forename: Eric
authors.initials: E
authors.lastname: Cuevas
authors.affiliation: Department of Transplantation, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México, Mexico Division of Internal Medicine, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México, Mexico.
authors.forename: José M
authors.initials: JM
authors.lastname: Arreola-Guerra
authors.affiliation: Department of Transplantation, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México, Mexico.
authors.forename: Erick A
authors.initials: EA
authors.lastname: Hernández-Méndez
authors.affiliation: Department of Transplantation, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México, Mexico.
authors.forename: Isaac
authors.initials: I
authors.lastname: Salcedo
authors.affiliation: Department of Transplantation, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México, Mexico.
authors.forename: Natalia
authors.initials: N
authors.lastname: Castelán
authors.affiliation: Department of Pathology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México, Mexico.
authors.forename: Norma O
authors.initials: NO
authors.lastname: Uribe-Uribe
authors.affiliation: Department of Transplantation, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México, Mexico.
authors.forename: Mario
authors.initials: M
authors.lastname: Vilatobá
authors.affiliation: Department of Transplantation, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México, Mexico.
authors.forename: Alan G
authors.initials: AG
authors.lastname: Contreras-Saldívar
authors.affiliation: Department of Transplantation, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México, Mexico.
authors.forename: Aczel I
authors.initials: AI
authors.lastname: Sánchez-Cedillo
authors.affiliation: Department of Transplantation, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México, Mexico.
authors.forename: Julia B
authors.initials: JB
authors.lastname: Ramírez
authors.affiliation: Department of Transplantation, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México, Mexico.
authors.forename: David
authors.initials: D
authors.lastname: de Rungs
authors.affiliation: Department of Transplantation, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México, Mexico.
authors.forename: Julio
authors.initials: J
authors.lastname: Granados
authors.affiliation: Department of Nephrology and Mineral Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México, Mexico.
authors.forename: Luis E
authors.initials: LE
authors.lastname: Morales-Buenrostro
authors.affiliation: Department of Transplantation, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México, Mexico.
authors.forename: Josefina
authors.initials: J
authors.lastname: Alberú
mesh_terms: D000328:Adult; D001323:Autoantibodies / Q000097:blood / Q000276:immunology*; D005260:Female; D006084:Graft Rejection / Q000097:blood / Q000175:diagnosis* / Q000209:etiology; D006085:Graft Survival; D006680:HLA Antigens / Q000276:immunology*; D006650:Histocompatibility Testing; D006801:Humans; D007518:Isoantibodies / Q000097:blood*; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D011237:Predictive Value of Tests; D044140:Receptor, Angiotensin, Type 1 / Q000276:immunology*; D012189:Retrospective Studies; D012307:Risk Factors; D014019:Tissue Donors
chemical_list: D001323:Autoantibodies; D006680:HLA Antigens; D007518:Isoantibodies; D044140:Receptor, Angiotensin, Type 1
keywords: acute rejection; angiotensin II type 1 receptor antibodies; de novo HLA donor-specific antibodies; kidney transplantation; non-HLA antibodies