Bradford Kathryn L, Pearl Meghan, Kohn Donald B, Weng Patricia, Yadin Ora, Bowles La Vette, De Oliveira Satiro N, Moore Theodore B
Department of Pediatrics, Division of Pediatric Hematology-Oncology, University of California, Los Angeles, Los Angeles, California.
Department of Pediatrics, Division of Pediatric Nephrology, University of California, Los Angeles, Los Angeles, California.
Biol Blood Marrow Transplant. 2020 Nov;26(11):2061-2067. doi: 10.1016/j.bbmt.2020.07.029. Epub 2020 Jul 28.
Angiotensin II type 1 receptor activating autoantibodies (AT1R-AAs) have gained attention in solid organ transplant as non-HLA antibodies associated with rejection, vasculopathy, and graft dysfunction. These antibodies have also been reported in the context of pre-eclampsia, scleroderma, and isolated hypertension. Here, we present 3 post-hematopoietic stem cell transplant (HSCT) cases with patients demonstrating elevated levels of AT1R-AAs detected within the first year post-HSCT. All patients had hypertension, and 2 patients exhibited profound diarrhea and hypokalemia. The hypertension, in all cases, was refractory to multiple classes of antihypertensives. Upon autoantibody identification, an angiotensin receptor blocker, losartan, was promptly initiated, and all patients showed blood pressure improvement. The 2 patients with electrolyte disturbances had rapid normalization of these levels and resolution of the diarrhea. These cases demonstrate a previously unreported association of elevated AT1R-AA levels in post-HSCT patients with a rapid response to angiotensin receptor blockade initiation.
血管紧张素II 1型受体激活自身抗体（AT1R - AAs）作为与排斥反应、血管病变和移植物功能障碍相关的非HLA抗体，在实体器官移植中受到了关注。这些抗体在子痫前期、硬皮病和孤立性高血压的背景下也有报道。在此，我们报告3例造血干细胞移植（HSCT）后病例，患者在HSCT后第一年内检测到AT1R - AAs水平升高。所有患者均患有高血压，2例患者出现严重腹泻和低钾血症。在所有病例中，高血压对多种类别的抗高血压药物均无效。在鉴定出自身抗体后，立即开始使用血管紧张素受体阻滞剂氯沙坦，所有患者的血压均有所改善。2例有电解质紊乱的患者这些指标迅速恢复正常，腹泻也得到缓解。这些病例表明，HSCT后患者中AT1R - AA水平升高与开始使用血管紧张素受体阻滞剂后迅速出现反应之间存在此前未报道的关联。
