Banasik Mirosław, Boratyńska Maria, Kościelska-Kasprzak Katarzyna, Kamińska Dorota, Bartoszek Dorota, Zabińska Marcelina, Myszka Marta, Zmonarski Sławomir, Protasiewicz Marcin, Nowakowska Beata, Hałoń Agnieszka, Chudoba Pawel, Klinger Marian
Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wroclaw, Poland.
Transpl Int. 2014 Oct;27(10):1029-38. doi: 10.1111/tri.12371. Epub 2014 Jun 30.
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 pretransplant 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 1st 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 antibody-mediated rejection (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 >9 U/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.
靶向血管受体的非HLA抗体（Abs）被认为会对肾移植损伤产生影响。抗血管紧张素II 1型受体激活抗体（抗AT1R）被提及可引发严重的血管排斥反应，但尚未开展移植前筛查。我们研究的目的是评估抗AT1R抗体的发生率和重要性及其在观察的第1年对肾移植的影响。我们前瞻性地评估了117例连续肾移植受者在移植前和移植后的筛查中抗AT1R抗体的存在情况。在分析的117例受者中，有27例（23%）在移植前就检测到了抗AT1R抗体。抗AT1R阳性组的肾移植功能明显更差。抗AT1R抗体>9 U/ml的患者更常失去移植肾。抗AT1R阳性组4/27（15%）的患者经活检证实发生急性排斥反应（AR），抗AT1R阴性组90例中有13例（14.4%）发生AR，但抗AT1R阳性组更常观察到更严重的Banff IIB级或抗体介导的排斥反应（AMR），抗AT1R阳性组为4/27（15%），抗AT1R阴性组为1/90（1.1%）（P = 0.009）。抗AT1R抗体水平>9 U/ml的患者发生移植失败的风险更高，且独立于经典的免疫风险因素。抗AT1R抗体阳性的受者发生更严重的急性排斥反应，在Banff分类中被描述为IIB级或AMR。抗AT1R阳性的受者中更多人失去了移植肾。我们的研究建议在肾移植前监测抗AT1R抗体，以评估免疫风险概况并识别对免疫事件、移植失败和移植肾丢失高度易感的患者。
