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Are AT1R Antibodies as Dangerous as HLA-DSAs in Renal Allografts?

E. Cuevas, J. Arreola-Guerra, E. Hernandez-Mendez, I. Salcedo, M. Vilatoba, A. Contreras, A. Sanchez-Cedillo, J. Ramirez, D. de Rungs, J. Granados, L. Morales-Buenrostro, J. Alberu.

1Transplantation, 1aNephrology-Mineral Metabolism, Inst Nal de Ciencias Medicas y Nutricion SZ, Mexico City, Distrito Federal, Mexico.

Meeting: 2015 American Transplant Congress

Abstract number: A96

Keywords: Antibodies, Graft function, Kidney transplantation, Rejection

Session Information

Session Name: Poster Session A: Kidney Antibody Mediated Rejection

Session Type: Poster Session

Date: Saturday, May 2, 2015

Session Time: 5:30pm-7:30pm

 Presentation Time: 5:30pm-7:30pm

Location: Exhibit Hall E

Angiotensin II type 1 receptor antibodies (AT1Rab) have been associated with a significantly lower graft survival and a higher risk of acute rejection after kidney transplantation. We previously reported a significantly lower eGFR (mL/min/1.73m2) at 1 & 12mos posttransplant, in a group of living donor (LD) kidney transplant recipients (KTR) who tested positive for AT1Rab (>17IU) & without HLA-DSA in pre-transplant sera, compared with a group of LD KTR with neither AT1Rab nor HLA-DSA. Methods. We prospectively gathered post-transplant blood samples from these patients in order to evaluate the incidence of both de novo AT1Rab & de novo HLA-DSA. Herein, we report the follow-up outcomes >12mos of this patient population in terms of graft function, and acute rejection (AR) according to pre- and posttransplant Ab status. Results. This study included 115 KTR. For analysis purposes, patients were divided into 4 groups: 1)with neither pre or post-transplant AT1Rab or HLA-DSA (w/o Abs), 2)AT1Rab+ve pre- and/or post-transplant, 3)HLA-DSA+ve pre-and/or post-transplant, 4)both AT1Rab and HLA-DSA+ve pre-and/or post-transplant. There were no differences in demographic characteristics between the groups, except for thymoglobulin induction of HLA-DSA+ve patients. Graft function follow-up and acute rejection (AR) rates are depicted in Table 1.

  w/o Abs (n=57) AT1Rab+ve (n=18) HLA-DSA+ (n=28) AT1Rab + HLA DSA (n=12) P
Follow-up period (mos) 37.6 (±13.4) 37.7 (±19.04) 36.7 (±11.4) 39.4 (±17.3) 0.95
eGFR at mo 12 73.2 (±18.2) 68.4 (±16.9) 65.5 (±22.2) 60.5 (±16.8) 0.109
eGFR at last follow-up 64.3 (±19.1) 64.1 (±17.2) 57.4 (±23) 53.3 (±22.2) 0.20
δ eGFR (mo3 – last f-u) -8.52 (±20.2) -6.5 (±15.1) -13.2 (±19.9) -14.3 (±16.3) 0.48
AR events (all), n(%) 12(21.8) 3(17.65) 13(43.3) 8(61.5) 0.011
AR (excl borderline) 4(7.27) 1(5.88) 9(30.0) 3(23.1) 0.020
Borderline 8(66.6 ) 2(66.6) 4(30.7) 5(62.5)  
Cellular AR 1(8.33) 1(33.3) 3(23.1) 1(12.5)  
Humoral AR 2(16.6) 0(0) 4(30.7) 1(12.5)  
Mixed AR 1(8.3) 0(0) 2(15.4) 1(12.5)  
Table 1

Conclusions. A significantly higher AR rate and a non-significant lower eGFR were observed at follow-up in KTR positive for HLA-DSA, independently of AT1Rab positivity. In fact, positive KTR for only pre- and/or post-transplant AT1Rabs, behave similarly to KTR w/o antibodies. These findings warrant a longer follow-up of these study groups.

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To cite this abstract in AMA style:

Cuevas E, Arreola-Guerra J, Hernandez-Mendez E, Salcedo I, Vilatoba M, Contreras A, Sanchez-Cedillo A, Ramirez J, Rungs Dde, Granados J, Morales-Buenrostro L, Alberu J. Are AT1R Antibodies as Dangerous as HLA-DSAs in Renal Allografts? [abstract]. Am J Transplant. 2015; 15 (suppl 3). https://atcmeetingabstracts.com/abstract/are-at1r-antibodies-as-dangerous-as-hla-dsas-in-renal-allografts/. Accessed May 8, 2025.

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