移植前儿童肾移植受者的血管紧张素 II 受体型 1 抗体：一项观察性队列研究。
Pre-transplant angiotensin II receptor type I antibodies in pediatric renal transplant recipients: An observational cohort study.
机构信息
Pediatric Nephrology, Cedars-Sinai Medical Center, Los Angeles, California, USA.
Biostatistics Core, Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA.
出版信息
Pediatr Transplant. 2022 Dec;26(8):e14400. doi: 10.1111/petr.14400. Epub 2022 Sep 27.
BACKGROUND
The role of angiotensin II type 1 receptor antibodies (AT1R-Ab) in pediatric renal transplantation is unclear. Here, we evaluated pre-transplant AT1R-Ab on transplant outcomes in the first 5 years. Secondary analysis compared pre-transplant AT1R-Ab levels by age.
METHODS
Thirty-six patients, 2-20 years old, were divided into two groups: pre-transplant AT1R-Ab- (<17 U/ml; n = 18) and pre-transplant AT1R-Ab+ (≥17 U/ml; n = 18). eGFR was determined at 6-month, 1-, 2-, and 4-year post-transplant. Allograft biopsies were performed in the setting of strong HLA-DSA (MFI > 10 000), AT1R-Ab ≥17 U/ml, and/or elevated creatinine.
RESULTS
Mean age in pre-transplant AT1R-Ab- was 13.3 years vs. 11.0 in pre-transplant AT1R-Ab+ (p = 0.16). At 6 months, mean eGFR was 111.3 ml/min/1.73 m in pre-transplant AT1R-Ab- vs. 100.2 in pre-transplant AT1R-Ab + at 1 year, 103.6 ml/min/1.73 m vs. 100.5; at 2 years, 98.9 ml/min/1.73 m vs. and 93.7; at 4 years, 72.6 ml/min/1.73 m vs. 80.9. 11/36 patients had acute rejection (6 in pre-transplant AT1R-Ab-, 5 in pre-transplant AT1R-Ab + ). There was no difference in rejection rates. All 6 subjects with de novo HLA-DSA and AT1R-Ab ≥17 U/ml at the time of biopsy experienced rejection. Mean age in those with the AT1R-Ab ≥40 U/ml was 10.0 years vs. 13.2 in those <40 U/ml (p = 0.07).
CONCLUSION
In our small cohort, pre-transplant AT1R-Ab ≥17 U/ml was not associated with reduced graft function or rejection. The pathogenicity of pre-transplant AT1R-Ab in pediatric kidney transplantation requires further investigation.
背景
血管紧张素 II 型 1 型受体抗体 (AT1R-Ab) 在儿科肾移植中的作用尚不清楚。在这里，我们评估了移植后前 5 年的移植结局中的预移植 AT1R-Ab。二次分析比较了按年龄划分的预移植 AT1R-Ab 水平。
方法
36 名年龄在 2-20 岁的患者分为两组：预移植 AT1R-Ab-（<17U/ml；n=18）和预移植 AT1R-Ab+（≥17U/ml；n=18）。在移植后 6 个月、1 个月、2 个月和 4 个月时测定 eGFR。在存在强烈 HLA-DSA（MFI>10000）、AT1R-Ab≥17U/ml 和/或肌酐升高的情况下进行同种异体肾活检。
结果
预移植 AT1R-Ab-的平均年龄为 13.3 岁，而预移植 AT1R-Ab+的平均年龄为 11.0 岁（p=0.16）。在 6 个月时，预移植 AT1R-Ab-的平均 eGFR 为 111.3ml/min/1.73m，而预移植 AT1R-Ab+为 100.2ml/min/1.73m；在 1 年时，预移植 AT1R-Ab-的平均 eGFR 为 103.6ml/min/1.73m，而预移植 AT1R-Ab+为 100.5ml/min/1.73m；在 2 年时，预移植 AT1R-Ab-的平均 eGFR 为 98.9ml/min/1.73m，而预移植 AT1R-Ab+为 93.7ml/min/1.73m；在 4 年时，预移植 AT1R-Ab-的平均 eGFR 为 72.6ml/min/1.73m，而预移植 AT1R-Ab+为 80.9ml/min/1.73m。36 例患者中有 11 例（6 例在预移植 AT1R-Ab-，5 例在预移植 AT1R-Ab+）发生急性排斥反应。排斥反应发生率无差异。所有 6 例在活检时出现新出现的 HLA-DSA 和 AT1R-Ab≥17U/ml 的患者均发生排斥反应。AT1R-Ab≥40U/ml 的患者的平均年龄为 10.0 岁，而 AT1R-Ab<40U/ml 的患者的平均年龄为 13.2 岁（p=0.07）。
结论
在我们的小队列中，预移植 AT1R-Ab≥17U/ml 与移植肾功能下降或排斥反应无关。预移植 AT1R-Ab 在儿科肾移植中的致病性需要进一步研究。
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