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Pretransplant sensitization against angiotensin II type 1 receptor is a risk factor for acute rejection and graft loss

Item Type:Article
Title:Pretransplant sensitization against angiotensin II type 1 receptor is a risk factor for acute rejection and graft loss
Creators Name:Giral, M. and Foucher, Y. and Dufay, A. and Van Huyen, J.P.D. and Renaudin, K. and Moreau, A. and Philippe, A. and Hegner, B. and Dechend, R. and Heidecke, H. and Brouard, S. and Cesbron, A. and Castagnet, S. and Devys, A. and Soulillou, J.P. and Dragun, D.
Abstract:The angiotensin II type 1 receptor (AT1 R) is an emerging target of functional non-HLA antibodies (Ab). We examined the potential of determining the degree of presensitization against AT1 R as a risk factor for graft survival and acute rejection (AR). The study included 599 kidney recipients between 1998 and 2007. Serum samples were analyzed in a blinded fashion for anti-AT1 R antibodies (AT1 R-Abs) using a quantitative solid-phase assay. A threshold of AT1 R-Ab levels was statistically determined at 10 U based on the time to graft failure. An extended Cox model determined risk factors for occurrence of graft failure and a first AR episode. AT1 R-Abs >10 U were detected in 283 patients (47.2%) before transplantation. Patients who had a level of AT1 R-Abs >10 U had a 2.6-fold higher risk of graft failure from 3 years posttransplantation onwards (p = 0.0005) and a 1.9-fold higher risk of experiencing an AR episode within the first 4 months of transplantation (p = 0.0393). Antibody-mediated rejection (AMR) accounted for 1/3 of AR, whereby 71.4% of them were associated with >10 U of pretransplant AT1 R-Abs. Pretransplant anti-AT1 R-Abs are an independent risk factor for long-term graft loss in association with a higher risk of early AR episodes.
Keywords:Acute Allograft Rejection, Allosensitization, Angiotensin II Receptors, Antibody Mediated Rejection, Pretransplant, Survival
Source:American Journal of Transplantation
Page Range:2567-2576
Date:October 2013
Official Publication:https://doi.org/10.1111/ajt.12397
PubMed:View item in PubMed

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