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Pretransplant Sensitization Against Angiotensin II Type 1 Receptor Is a Risk Factor for Acute Rejection and Graft Loss
Author(s) -
Giral M.,
Foucher Y.,
Dufay A.,
Van Huyen J. P. D.,
Renaudin K.,
Moreau A.,
Philippe A.,
Hegner B.,
Dechend R.,
Heidecke H.,
Brouard S.,
Cesbron A.,
Castagnet S.,
Devys A.,
Soulillou J. P.,
Dragun D.
Publication year - 2013
Publication title -
american journal of transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.89
H-Index - 188
eISSN - 1600-6143
pISSN - 1600-6135
DOI - 10.1111/ajt.12397
Subject(s) - medicine , angiotensin ii , risk factor , transplantation , kidney transplantation , antibody , sensitization , gastroenterology , receptor , urology , immunology
Abstract The angiotensin II type 1 receptor (AT 1 R) is an emerging target of functional non‐HLA antibodies (Ab). We examined the potential of determining the degree of presensitization against AT 1 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‐AT 1 R antibodies (AT 1 R‐Abs) using a quantitative solid‐phase assay. A threshold of AT 1 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. AT 1 R‐Abs >10 U were detected in 283 patients (47.2%) before transplantation. Patients who had a level of AT 1 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 AT 1 R‐Abs. Pretransplant anti‐AT 1 R‐Abs are an independent risk factor for long‐term graft loss in association with a higher risk of early AR episodes.