Alexander Fuss1,2, Christopher M Hope1,2, Susan Deayton3, Greg Donald Bennett3, Rhonda Holdsworth3, Robert P Carroll1,2, P Toby H Coates1,2. 1. The Centre for Clinical and Experimental Transplantation (CCET), Central Northern Adelaide Renal and Transplantation Services (CNARTS), Adelaide, South Australia, Australia. 2. Department of Medicine, The University of Adelaide, Adelaide, South Australia, Australia. 3. Adelaide Division, Australian Red Cross Blood Service (ARCBS), Adelaide, South Australia, Australia.
Abstract
AIMS: Acute antibody-mediated rejection can occur in absence of circulating donor-specific antibodies. Agonistic antibodies targeting the anti-angiotensin II type 1 receptor (anti-AT1 R) are emerging as important non-human leucocyte antigen (HLA) antibodies. Elevated levels of anti-angiotensin II receptor antibodies were first observed in kidney transplant recipients with malignant hypertension and allograft rejection. They have now been studied in three separate kidney transplant populations and associate to frequency of rejection, severity of rejection and graft failure. METHODS: We report 11 cases of biopsy-proven, Complement 4 fragment d (C4d)-negative, acute rejection occurring without circulating donor-specific anti-HLA antibodies. In eight cases, anti-angiotensin receptor antibodies were retrospectively examined. The remaining three subjects were identified from our centre's newly instituted routine anti-angiotensin receptor antibody screening. RESULTS: All subjects fulfilled Banff 2013 criteria for antibody-mediated rejection and all responded to anti-rejection therapy, which included plasma exchange and angiotensin receptor blocker therapy. CONCLUSIONS: These cases support the routine assessment of anti-AT1 R antibodies in kidney transplant recipients to identify subjects at risk. Further studies will need to determine optimal assessment protocol and the effectiveness of pre-emptive treatment with angiotensin receptor blockers.
AIMS: Acute antibody-mediated rejection can occur in absence of circulating donor-specific antibodies. Agonistic antibodies targeting the anti-angiotensin II type 1 receptor (anti-AT1 R) are emerging as important non-human leucocyte antigen (HLA) antibodies. Elevated levels of anti-angiotensin II receptor antibodies were first observed in kidney transplant recipients with malignant hypertension and allograft rejection. They have now been studied in three separate kidney transplant populations and associate to frequency of rejection, severity of rejection and graft failure. METHODS: We report 11 cases of biopsy-proven, Complement 4 fragment d (C4d)-negative, acute rejection occurring without circulating donor-specific anti-HLA antibodies. In eight cases, anti-angiotensin receptor antibodies were retrospectively examined. The remaining three subjects were identified from our centre's newly instituted routine anti-angiotensin receptor antibody screening. RESULTS: All subjects fulfilled Banff 2013 criteria for antibody-mediated rejection and all responded to anti-rejection therapy, which included plasma exchange and angiotensin receptor blocker therapy. CONCLUSIONS: These cases support the routine assessment of anti-AT1 R antibodies in kidney transplant recipients to identify subjects at risk. Further studies will need to determine optimal assessment protocol and the effectiveness of pre-emptive treatment with angiotensin receptor blockers.
Authors: Meghan H Pearl; Qiuheng Zhang; Miguel Fernando Palma Diaz; Jonathan Grotts; Maura Rossetti; David Elashoff; David W Gjertson; Patricia Weng; Elaine F Reed; Eileen Tsai Chambers Journal: Kidney Int Date: 2017-09-18 Impact factor: 10.612
Authors: Jian Zhang; Mingxu Wang; Jun Liang; Ming Zhang; Xiao-Hong Liu; Le Ma Journal: Int J Environ Res Public Health Date: 2017-05-09 Impact factor: 3.390