Premium
Angiotensin II type I receptor agonistic autoantibodies are associated with poor allograft survival in liver retransplantation
Author(s) -
Xu Qingyong,
McAlister Vivian C.,
Leckie Steve,
House Andrew A.,
Skaro Anton,
Marotta Paul
Publication year - 2020
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.15571
Subject(s) - medicine , liver transplantation , gastroenterology , angiotensin ii , transplantation , autoantibody , confounding , cohort , retrospective cohort study , endocrinology , urology , receptor , immunology , antibody
Angiotensin II type I receptor ( AT 1R) agonistic autoantibodies ( AT 1R‐ AA ) are detrimental to kidney transplantation. Early studies suggested a similar negative effect in primary liver transplantation. Here, we studied AT 1R‐ AA in a retrospective cohort of 94 patients who received a second liver transplant to determine their prevalence and effects. The concentrations of preformed AT 1R‐ AA before transplantation were higher ( P = .019) in the 48 patients who lost their liver grafts than in the 46 patients whose grafts survived. About half (48/94, 51.1%) of the patients were positive for AT 1R‐ AA >17 U/ mL before the second liver transplantation. In 22 (23.4%) patients, strong positive AT 1R‐ AA (defined as >40 U/ mL ) were detected, of whom 16 (72.7%) patients lost their grafts. Based on Kaplan‐Meier analysis, patients with strong positive AT 1R‐ AA had significantly worse graft survival than those with AT 1R‐ AA <40 U/ mL ( P = .035). In multivariate Cox models that included confounders such as sex and age, either AT 1R‐ AA >40 U/ mL ( HR = 1.999 [1.085‐3.682], P = .026) or increased concentrations of AT 1R‐ AA ( HR = 1.003 [1.001‐1.006] per incremental U/ mL , P = .019) were significantly associated with elevated risk for graft loss. In conclusion, our data indicate that there is a high prevalence of AT 1R‐ AA in candidates for second liver transplantation and that their presence is associated with inferior long‐term outcomes of the second graft.