Histopathologic changes in anti-angiotensin II type 1 receptor antibody-positive kidney transplant recipients with acute rejection and no donor specific HLA antibodies

作者：Lim Mary Ann^*; Palmer Matthew; Trofe Clark Jennifer; Bloom Roy D; Jackson Annette; Philogene Mary Carmelle; Kamoun Malek

来源：Human Immunology, 2017, 78(4): 350-356.

DOI：10.1016/j.humimm.2017.03.004

• Anti-angiotensin II
• Antibody
• Rejection
• Non-HLA
• Kidney transplant

Objective: To determine the association of antibodies against angiotensin II type 1 receptor (AT1R Ab) and histopathologic changes seen in patients with kidney allograft rejection and negative donor specific HLA antibodies (DSA).
Methods: Stored sera from 27 patients who had biopsy-proven rejection in the absence of DSA were tested for AT1R Ab. Biopsy slides of all patients were re-examined and classified according to Banff 2013 criteria. Histopathologic changes were compared between AT1R positive and negative patients.
Results: 75% of patients with positive pre-transplant AT1R Ab had antibody mediated rejection (AMR) compared to 37% of AT1R Ab-negative patients. A trend towards increased interstitial inflammation was observed in the AT1R Ab positive group (p = 0.08). More patients in the AT1R Ab positive group had microcirculation inflammation (88% vs 58% with glomerulitis scores >1; 75% vs 58% with peritubular capillaritis scores >1).
Conclusion: In kidney transplant recipients with rejection and no DSA, a higher incidence of AMR and worse inflammation scores are observed in the presence of positive pre-transplant AT1R antibodies.

• 出版日期2017-4