Carroll Robert P, Riceman Michael, Hope Christopher M, Zeng Anna, Deayton Sue, Bennett Greg D, Coates P T
Central Northern Adelaide Renal and Transplantation Services (CNARTS), Adelaide, Australia; The University of Adelaide, Department of Medicine, Adelaide, Australia; Australian Red Cross Blood Service (ARCBS), Adelaide, Australia; University South Australia, Adelaide, Australia.
Central Northern Adelaide Renal and Transplantation Services (CNARTS), Adelaide, Australia; The University of Adelaide, Department of Medicine, Adelaide, Australia.
Hum Immunol. 2016 Dec;77(12):1154-1158. doi: 10.1016/j.humimm.2016.08.009. Epub 2016 Aug 16.
Angiotensin II type 1 antibodies (AT1Rab) can mediate antibody mediated rejection (AMR). Pre transplant AT1Rab levels, and risk of rejection were assessed in Kidney Transplant Recipients (KTR) transplanted in our centre from 2013 to 2014 (n=145). 14/145 (9.7%) KTR experienced antibody mediated rejection (AMR). The Hazard Ratio for AMR=3.7 [95% CI 2-26] (p=0.009) for KTR with AT1Rab levels >17.5U/ml. 6/11 of KTR with levels >25U/ml experienced AMR. In 2015 (n=80) KTR were transplanted and 6/80 KTR experienced rejection (2 AMR and 4 TCMR with vascular lesions). 7/80 of KTR had AT1Rab 17.5-25U/ml and none experienced rejection and were induced with ATG and candesartan. 7/80 had AT1Rab 25-40U/ml and received pre and post-operative plasma exchange, ATG and candesartan and 1/7 experienced TCMR with a vascular lesion. This perioperative regimen may alter the risk of rejection in patients with high levels of AT1Ab and further studies are needed.
血管紧张素II 1型抗体（AT1Rab）可介导抗体介导的排斥反应（AMR）。对2013年至2014年在本中心接受肾移植的肾移植受者（KTR，n = 145）进行了移植前AT1Rab水平及排斥反应风险评估。145名KTR中有14名（9.7%）发生了抗体介导的排斥反应（AMR）。AT1Rab水平>17.5U/ml的KTR发生AMR的风险比为3.7 [95%可信区间2 - 26]（p = 0.009）。AT1Rab水平>25U/ml的KTR中有6/11发生了AMR。2015年有80名KTR接受了移植，其中6名发生了排斥反应（2例AMR和4例伴有血管病变的传统细胞介导排斥反应[TCMR]）。80名KTR中有7名的AT1Rab水平为17.5 - 25U/ml，均未发生排斥反应，接受了抗胸腺细胞球蛋白（ATG）和坎地沙坦诱导治疗。80名KTR中有7名的AT1Rab水平为25 - 40U/ml，接受了术前和术后血浆置换、ATG和坎地沙坦治疗，其中1/7发生了伴有血管病变的TCMR。这种围手术期治疗方案可能会改变AT1Ab水平高的患者发生排斥反应的风险，需要进一步研究。
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