Division of Nephrology and Dialysis, ASO Civico, Chivasso, Italy.
Renal Transplantation Center, "A. Vercellone", Division of Nephrology Dialysis and Transplantation, Città della Salute e della Scienza Hospital and Department of Medical Sciences, University of Turin, Turin, Italy.
Clin Transplant. 2018 Nov;32(11):e13407. doi: 10.1111/ctr.13407. Epub 2018 Nov 22.
Transplant glomerulopathy (TG) is an important cause of late graft loss. The role of angiotensin type 1-receptor antibodies (AT R-Ab) in TG is not known.
All the TG cases (N = 137) between January 2007 and December 2014 (N = 1410) were analyzed. Donor-specific anti-HLA antibodies (DSA) at the time of biopsy and AT R-Ab IgG (positive, >17 UI/mL; "at risk," 10-17 UI/mL; negative, <10 UI/mL) in pre-transplant sera (PT-Ab) and at biopsy time (BT-Ab) were studied.
AT R-PT-Ab and AT R-BT-Ab patients were 16.5% (51.5% "at risk") and 11.5% (27.4% "at risk"), respectively. Clinical correlations were found between AT R-Ab and HCV infection, number of transplants, and age. Considering Banff scores, ptc was higher in DSA patients vs AT R-PT-Ab (P = 0.002) or AT R-BT-Ab (P = 0.001) without differences in g and chronicity score (ci + ct); cg showed lower scores in DSA patients vs AT R-BT-Ab (P = 0.001). Graft survival was not influenced by the presence of AT R-Ab, AT1-R-Ab titer or MFI, but we observed a longer graft survival in patients with both AT R-BT-Ab or "at risk" and DSA vs patients positive only for DSA (P = 0.02), for AT R-BT-Ab (P = 0.019) or AT R-BT-Ab "at risk" (P = 0.039).
AT R-Ab showed no independent prognostic role in TG in this pilot analysis.
移植肾小球病（TG）是晚期移植物丢失的重要原因。血管紧张素 1 型受体抗体（AT R-Ab）在 TG 中的作用尚不清楚。
分析了 2007 年 1 月至 2014 年 12 月间的所有 TG 病例（n=137）（n=1410）。研究了活检时的供体特异性抗 HLA 抗体（DSA）以及移植前血清（PT-Ab）和活检时的 AT R-Ab IgG（阳性，>17 UI/mL；“高危”，10-17 UI/mL；阴性，<10 UI/mL）。
AT R-PT-Ab 和 AT R-BT-Ab 患者分别为 16.5%（51.5%“高危”）和 11.5%（27.4%“高危”）。AT R-Ab 与 HCV 感染、移植次数和年龄之间存在临床相关性。考虑到 Banff 评分，与 AT R-PT-Ab（P=0.002）或 AT R-BT-Ab（P=0.001）相比，DSA 患者的 ptc 更高，但 g 和慢性评分（ci+ct）没有差异；与 AT R-BT-Ab 相比，DSA 患者的 cg 评分较低（P=0.001）。移植物存活率不受 AT R-Ab、AT1-R-Ab 滴度或 MFI 的影响，但我们观察到同时存在 AT R-BT-Ab 或“高危”和 DSA 的患者与仅存在 DSA 阳性的患者相比（P=0.02），与仅存在 AT R-BT-Ab 阳性的患者相比（P=0.019）或 AT R-BT-Ab“高危”的患者相比（P=0.039），移植物存活率更长。
在这项初步分析中，AT R-Ab 在 TG 中没有独立的预后作用。
