Non-HLA antibodies (Abs) targeting vascular receptors are thought to have an impact on renal transplant injury. Anti-Angiotensin II type 1-receptor activating antibodies (anti-AT1R) have been mentioned to stimulate a severe vascular rejection but the pre-transplant screening has not been introduced yet.
The aim of our study was to assess the incidence and importance of anti-AT1R antibodies and their influence on renal transplant in the first year of observation.
We prospectively evaluated the presence of anti-AT1R antibodies in 117 consecutive renal transplant recipients in pre- and post-transplant screening.
Anti-AT1R antibodies were observed in 27/117(23%) of the analyzed recipients already before transplantation. The function of renal transplant was considerably worse in anti-AT1R(+) group. The patients with anti-AT1R Abs >9 U/mL lost their graft more often.
Biopsy proven AR was described in 4/27(15%) pts in the anti-AT1R(+) group and 13/90(14.4%) in the anti-AT1R(-) group but more severe cases of Banff IIB or AMR were more often observed in anti-AT1R (+) 4/27(15%) vs. 1/90(1.1%) in anti-AT1R(+) (p=0.009).
Patients with anti-AT1R Abs level >9U/mL run a higher risk of graft failure independently of classical immunological risk factors. The recipients with anti-AT1R Abs developed more severe acute rejections described as IIB or AMR in Banff classification. More recipients among the anti-AT1R positive ones lost the graft. Our study suggests monitoring of anti-AT1R Abs before renal transplantation for assessment of immunologic risk profiles and the identification of patients highly susceptible to immunologic events, graft failure and graft loss (read more)
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