Isolated De Novo Antiendothelial Cell Antibodies and Kidney Transplant Rejection.
BACKGROUND
Studies analyzing the role of antiendothelial cell antibodies (AECAs) in large series of kidney transplant recipients are scarce, and HLA, MHC (major histocompatibility complex) class I-related chain A (MICA), and angiotensin II type 1 receptor have not been formally excluded as targets.


METHODS
Retrospective study of a cohort of kidney transplant recipients.


METHODS
324 kidney transplant recipients who were negative for anti-HLA, anti-MICA, and anti-angiotensin II type 1 receptor antibodies were tested for AECAs in pre- and posttransplantation serum samples.


METHODS
AECA-positive (preformed [pre+/post+] vs de novo [pre-/post+]) versus AECA-negative (pre-/post-) before or after transplantation.


RESULTS
Patient mortality, transplant loss, and acute rejection events.


RESULTS
66 (20%) patients were AECA positive (39 [12%] preformed, 27 [8%] de novo) and 258 (80%) were AECA negative. During a follow-up of 10 years, 7 (18%) AECA pre+/post+patients had rejections compared with 14 (52%) AECA pre-/post+and 57 (22%) AECA pre-/post-recipients (OR, 3.80; P=0.001). AECA pre-/post+status emerged as an independent risk factor for transplant rejection compared to the AECA pre-/post-group (OR, 5.17; P<0.001). However, AECA pre+/post+and AECA pre-/post+patients did not show higher risk for either patient death (ORs of 1.49 [P=0.7] and 1.06 [P=0.9], respectively) or transplant loss (ORs of 1.22 and 0.86, respectively; P for both = 0.8) compared to the AECA pre-/post-population.


CONCLUSIONS
Retrospective study. Posttransplantation sera were collected before or after rejection, entailing a nearly cross-sectional relationship between the exposure and outcome. Lack of identification of precise antigens for AECAs.


CONCLUSIONS
De novo AECAs may be associated with rejection. These antibodies might serve as biomarkers of endothelium damage in kidney transplant recipients.
Department of Immunology, Hospital Universitario 12 de Octubre, Madrid, Spain. Electronic address: eszapardiel@gmail.com.
Elena
E
Sánchez-Zapardiel
Department of Immunology, Hospital Universitario 12 de Octubre, Madrid, Spain; Research Institute I+12, Hospital Universitario 12 de Octubre, Madrid, Spain.
Esther
E
Mancebo
School of Medicine, Universidad Complutense de Madrid, Madrid, Spain.
María
M
Díaz-Ordoñez
School of Medicine, Universidad Complutense de Madrid, Madrid, Spain.
Lucía
L
de Jorge-Huerta
School of Medicine, Universidad Complutense de Madrid, Madrid, Spain.
Lara
L
Ruiz-Martínez
Department of Immunology, Hospital Universitario 12 de Octubre, Madrid, Spain; Research Institute I+12, Hospital Universitario 12 de Octubre, Madrid, Spain; Section of Immunology, Universidad San Pablo CEU, Madrid, Spain.
Antonio
A
Serrano
Department of Immunology, Hospital Universitario 12 de Octubre, Madrid, Spain; Research Institute I+12, Hospital Universitario 12 de Octubre, Madrid, Spain.
María J
MJ
Castro-Panete
Research Institute I+12, Hospital Universitario 12 de Octubre, Madrid, Spain; School of Medicine, Universidad Complutense de Madrid, Madrid, Spain.
Alberto
A
Utrero-Rico
Department of Nephrology, Hospital Universitario 12 de Octubre, Madrid, Spain.
Amado
A
de Andrés
Research Institute I+12, Hospital Universitario 12 de Octubre, Madrid, Spain; Department of Nephrology, Hospital Universitario 12 de Octubre, Madrid, Spain.
José M
JM
Morales
School of Medicine, Universidad Complutense de Madrid, Madrid, Spain.
Sara
S
Domínguez-Rodríguez
Department of Immunology, Hospital Universitario 12 de Octubre, Madrid, Spain; Research Institute I+12, Hospital Universitario 12 de Octubre, Madrid, Spain; School of Medicine, Universidad Complutense de Madrid, Madrid, Spain; Section of Immunology, Universidad San Pablo CEU, Madrid, Spain.
Estela
E
Paz-Artal
D034961:Antigens, Nuclear / Q000276:immunology; D001323:Autoantibodies / Q000276:immunology* / Q000302:isolation & purification; D003430:Cross-Sectional Studies; D003599:Cytoskeleton / Q000276:immunology; D005260:Female; D006084:Graft Rejection / Q000276:immunology*; D006801:Humans; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
D034961:Antigens, Nuclear; D001323:Autoantibodies; C087589:anti-endothelial cell antibody
Anti-endothelial cell antibodies (AECAs); acute rejection; allograft loss; allograft rejection; de novo antibodies; immunofluorescence patterns; kidney transplantation; mortality