Angiotensin II type 1 receptor antibodies (AT1Rabs) have been associated with acute allograft rejection and graft loss. The possible implication of the generation of de novo HLA-DSA has been explored by our group and we have found an association between pre transplant AT1Rabs and de novo DSA development. Aim: to explore the association of posttransplant (RT) AT1Rabs and the development of de novo HLA-DSA. Methodology: Retrospective cohort study of kidney transplant recipients (KTR) between 03/2009 and 09/2013. All patients had pre-KT HLA-DSA and AT1Rabs (One Lambda, Canoga Park, CA, USA) determined. Posttransplant HLA-DSA were measured at different time-points and AT1Rabs once, at a median of 2.7 yr. HLA-DSA > 1000 MFI was considered positive. Results: 94 patients were included: mean age 32.5 (±11.6); male gender 54.2 %. Mean post-KT AT1Rabs level was 10.3 U (IQR 8.3 – 14.1), higher than pre-KT level (7.59, IQR 4.3 – 12.2) (p <0.001). 42 patients developed de novo HLA-DSA during follow-up. Four groups of patients were conformed according to AT1R levels (2.5 – 8.3 U, 8.31 – 10.37, 10.38 – 14.0 and > 14 U). Patients with post-KT AT1Rabs > 14 U developed earlier de novo HLA-DSA (Log Rank, p= 0.025). After multivariate analysis, post-KT AT1Rabs > 14 U (HR 2.14, 1.03 – 4.43, p=0.041), pre-KT AT1Rabs HR 1.02, 1.002 – 1.05 p=0.032), Borderline/Cellular acute rejection (HR 2.28, 1.19 – 4.35, p=0.013), and donor age (HR 0.95, 0.92 – 0.99, p=0.012) remained significant. Conclusions: Compared to pre-KT, post-KT AT1Rabs levels increased significantly. Post-KT AT1Rabs are associated with de novo DSA development.

CITATION INFORMATION: Arreola-Guerra J, Cuevas E, Hernandez-Mendez E, Vilatoba M, Contreras A, Ramirez J, de Rongs D, Granados J, Morales-Buenrostro L, Alberu J. Posttransplant AT1Rabs Precede De Novo HLA-DSA Development. Am J Transplant. 2016;16 (suppl 3).

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