Background: Anti-angiotensin type 1 receptor antibodies (AT1R Ab) have been found to have a strong association with antibody mediated rejection (Reinsmoen et al, Transpl 2010; 90(12):1473-7) and a higher risk of kidney graft failure (Taniguchi et al, AJT 2013; 13(10):2577-89). AT1R Ab has also been associated with an increased risk of both antibody and cell mediated rejection in heart transplantation (Reinsmoen et al, ATC 2013, C1443). To date, there is no published data regarding the impact of AT1R Ab in pancreas transplantation. Here we report the impact of AT1R Ab on clinical outcomes in pancreas transplant recipients (PTx). Methods: PTx from November of 2012 through May of 2016 (to allow for at least 6 months post-transplant follow-up) were evaluated for presence of AT1R Ab (ELISA with high levels defined as >16, intermediate 11-16, negative <11). 35 PTx were identified, 30 SPK and 5 PTA/PAK. Clinical parameters examined were rejection (pancreas and kidney) and pancreas graft survival. Results: Of the 35 PTx, 7 had strong AT1R Ab, 11 had intermediate, and 17 had negative titers. Rates of pancreas allograft rejection were 71%, 9% and 11% respectively. Rates of kidney rejection by AT1R Ab status were 50%, 11%, and 27%. Pancreas graft survival was 57%, 91%, and 88% in the strong, intermediate, and negative AT1R Ab groups respectively. All 3 pancreas graft failures (defined as resumption of insulin) in the strong AT1R Ab group were attributed to rejection. The 1 intermediate PTx graft failure was secondary to immediate thrombosis. Of the 2 graft failures in the negative AT1R group, 1 was lost to early anastomotic leak and the other was attributed to rejection in the setting of a peripancreatic abscess. In the 29 of 35 patients without evidence of HLA sensitization, pancreas rejection rates were highest in the strong AT1R Ab group (60%), with intermediate and negative AT1R Ab rejection rates of 11% and 6%. The rates of rejection in the strong vs (intermediate + negative combined) AT1R Ab groups were significantly different by Chi-square test (p=0.000623). Conclusion: The presence of strong AT1R Ab levels is associated with an increased risk of rejection and graft loss in PTx. Thus, determining AT1R Ab may be useful in assessing overall immunologic risk and help to determine appropriate clinical management in pancreas transplant recipients.

CITATION INFORMATION: Peng A, Dafoe D, Choi J, Vo A, Zhang X, Najjar R, Huang E, Jordan S. Anti-Angiotensin Type 1 Receptor Antibodies Associate with Rejection in Simultaneous Pancreas and Kidney Transplant and Pancreas Transplant Alone Recipients. Am J Transplant. 2017;17 (suppl 3).

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