Department of Blood Transfusion, Tianjin First Central Hospital, 24 Fukang Road, Tianjin, Nankai, China.
Nephrol Dial Transplant. 2022 May 25;37(6):1171-1180. doi: 10.1093/ndt/gfab344.
Anti-angiotensin II type 1 receptor antibodies (AT1R-Abs) have been recognized as non-human leukocyte antigen antibodies associated with allograft rejection and poor allograft outcomes after kidney transplantation. The aim of this study was to assess the risk anti-AT1R-Abs pose for rejection and graft loss among kidney transplant (KT) populations.
We systematically searched PubMed, Embase and the Cochrane Library databases for relevant articles published from inception until June 2021 to identify all studies concerning the role AT1R-Abs play in the clinical outcome after kidney transplantation. Two reviewers independently identified studies, abstracted outcome data and assessed the quality of the studies. The meta-analysis was summarized using fixed-effects or random-effects models, according to heterogeneity. The major outcomes included delayed graft function, acute rejection, graft loss or patient death after transplantation.
Twenty-one eligible studies involving a total of 4023 KT recipients were included in the evaluation. Meta-analysis results showed that the AT1R-Ab-positive KT group had a greater incidence of antibody-mediated rejection {relative risk [RR] 1.94 [95% confidence interval (CI) 1.61-2.33]; P < 0.00001} and graft loss [RR 2.37 (95% CI 1.50-3.75); P = 0.0002] than did the AT1R-Abs-negative KT group. There was no significant statistical difference in delayed graft function rate, T-cell-mediated rejection, mixed rejection, acute cellular rejection, acute rejection and patient death rate between the AT1R-Ab-positive KT and AT1R-Ab-negative KT groups.
Our study shows that the presence of anti-AT1R-Abs was associated with a significantly higher risk of antibody-mediated rejection and graft loss in kidney transplantation. Future studies are still needed to evaluate the importance of routine anti-AT1R monitoring and therapeutic targeting. These results show that assessment of anti-AT1R-Abs would be helpful in determining immunologic risk and susceptibility to immunologic events for recipients.
抗血管紧张素 II 型 1 型受体抗体（AT1R-Abs）已被认为是与同种异体肾移植排斥反应和移植物不良结局相关的非人类白细胞抗原抗体。本研究旨在评估抗 AT1R-Abs 对肾移植（KT）人群排斥反应和移植物丢失的风险。
我们系统地检索了 PubMed、Embase 和 Cochrane 图书馆数据库，以确定从成立到 2021 年 6 月期间所有关于 AT1R-Abs 在肾移植后临床结局中作用的相关研究。两位审查员独立识别研究、提取结局数据并评估研究质量。根据异质性，使用固定效应或随机效应模型总结荟萃分析结果。主要结局包括移植后延迟移植物功能、急性排斥反应、移植物丢失或患者死亡。
共有 21 项符合条件的研究纳入了总共 4023 例 KT 受者的评估。荟萃分析结果表明，AT1R-Ab 阳性 KT 组发生抗体介导的排斥反应的发生率更高{相对风险 [RR] 1.94 [95%置信区间 (CI) 1.61-2.33]；P < 0.00001}和移植物丢失[RR 2.37 (95% CI 1.50-3.75)；P = 0.0002]比 AT1R-Ab 阴性 KT 组。AT1R-Ab 阳性 KT 组和 AT1R-Ab 阴性 KT 组在延迟移植物功能发生率、T 细胞介导的排斥反应、混合排斥反应、急性细胞性排斥反应、急性排斥反应和患者死亡率方面无统计学差异。
本研究表明，抗 AT1R-Abs 的存在与肾移植中抗体介导的排斥反应和移植物丢失的风险显著增加相关。未来仍需要研究来评估常规抗 AT1R 监测和治疗靶向的重要性。这些结果表明，评估抗 AT1R-Abs 有助于确定受者的免疫风险和对免疫事件的易感性。
