Angiotensin II Type-1 Receptor Antibodies are Associated with Inferior Renal Allograft Survival
Renal Department, Imperial College Healthcare NHS Trust, London, United Kingdom
Meeting: 2021 American Transplant Congress
Abstract number: 179
Keywords: Antibodies, Kidney transplantation, Rejection, Vascular disease
Topic: Clinical Science » Kidney » Kidney Complications: Immune Mediated Late Graft Failure
Session Information
Session Name: Kidney Complications
Session Type: Rapid Fire Oral Abstract
Date: Sunday, June 6, 2021
Session Time: 6:00pm-7:00pm
Presentation Time: 6:30pm-6:35pm
Location: Virtual
*Purpose: AT1R-antibodies have been implicated in antibody-mediated vascular rejection in the absence of detectable HLA donor specific antibody (DSA), in addition to cardiovascular diseases. Transplant renal artery stenosis (TRAS) or macrovascular disease has also been shown to be associated with rejection. We aim to investigate the prevalence and outcomes of AT1R antibodies in patients undergoing angiography for suspected TRAS with biopsy proven rejection.
*Methods: 82 patients with no HLA DSA were identified and serum at the time of angiography was tested for AT1R-Abs using an enzyme-linked immunosorbent assay technique. A threshold of >17u/ml was considered a positive result. Prospectively collected outcomes up to 5 years were obtained from our unit’s transplant registry.
*Results: The prevalence of AT1R-Abs was high at 21/82 (26%). 49/82 (59.8%) of patients were found to have significant TRAS at the time of angiography, 13/49 (26.5%) of patients with TRAS had Abs compared with 8/33 (24.2%) of patients with no TRAS, p=0.82. There was no difference in gender, ethnicity, donor type, cause of ESKD, total HLA mismatch in the Ab positive versus Ab negative groups. However, Ab+ patients were more likely to be younger than Ab- patients, 46.9±12.2 versus 54.4±12.0 respectively, p=0.017. AT1R-Ab+ patients at the time of angiography had an inferior 5-year allograft survival compared with Ab- patients, p=0.017 (fig. 1). Outcome by TRAS and Ab status, showed that TRAS+Ab+ patients had significantly worse outcomes than either TRAS+Ab- and TRAS-Ab+ patients, p=0.009 (fig. 2).
*Conclusions: In a highly selected patient population, we found a high prevalence of AT1R-Abs. Although we found no association with TRAS, further work is underway to compare the prevalence with patients with normal renal artery imaging. Importantly, we did find a negative association with allograft survival, which highlights the potential importance of AT1R-Abs in renal transplantation which warrants further investigation.
To cite this abstract in AMA style:
Martin P, Santos E, Gunby N, Willicombe M. Angiotensin II Type-1 Receptor Antibodies are Associated with Inferior Renal Allograft Survival [abstract]. Am J Transplant. 2021; 21 (suppl 3). https://atcmeetingabstracts.com/abstract/angiotensin-ii-type-1-receptor-antibodies-are-associated-with-inferior-renal-allograft-survival/. Accessed May 16, 2025.« Back to 2021 American Transplant Congress