Ann Lab Med 2018; 38(5): 450-457  
Clinical Impact of Pre-transplant Antibodies Against Angiotensin II Type I Receptor and Major Histocompatibility Complex Class I-Related Chain A in Kidney Transplant Patients
Ji Won Min, M.D.1*, Hyeyoung Lee, M.D.2,3*, Bum Soon Choi, M.D.4, Cheol Whee Park, M.D.4, Chul Woo Yang, M.D.4, Yong-Soo Kim, M.D.4, Yeong Jin Choi, M.D.5, Eun-Jee Oh, M.D.2, and Byung Ha Chung, M.D.4
Division of Nephrology, Department of Internal Medicine1, Bucheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Bucheon; Department of Laboratory Medicine2, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul; Department of Laboratory Medicine3, Catholic Kwandong University International St. Mary’s Hospital, Incheon; Division of Nephrology, Department of Internal Medicine4, Department of Hospital Pathology5, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
Corresponding author: Eun-Jee Oh
https://orcid.org/0000-0001-5870-915X
Department of Laboratory Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 06591, Korea
Tel: +82-2-2258-1641
Fax: +82-2-2258-1719
E-mail: ejoh@catholic.ac.kr
Co-corresponding author: Byung Ha Chung
https://orcid.org/0000-0003-0048-5717
Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 06591, Korea
Tel: +82-2-2258-6066
Fax: +82-2-536-0323
E-mail: chungbh@catholic.ac.kr
*These authors contributed equally to this work.
Received: September 25, 2017; Revised: November 27, 2017; Accepted: May 6, 2018; Published online: September 1, 2018.
© Korean Society for Laboratory Medicine. All rights reserved.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Background: Evidence of antibody-mediated injury in the absence of donor-specific HLA antibodies (HLA-DSA) has recently emerged, suggesting a role of antibodies in targeting non-HLA antigens expressed on renal allograft tissue. However, the clinical significance of pre-transplant non-HLA antibodies remains unclear. We compared the histological and clinical impact of pre-transplant HLA-DSA and non-HLA antibodies, especially angiotensin II type I receptor (anti-AT1R) and MHC class I-related chain A (anti-MICA), in kidney transplant patients.
Methods: Pre-transplant HLA-DSA, anti-AT1R, and anti-MICA were retrospectively examined in 359 kidney transplant patients to determine the effect of each antibody on allograft survival and clinical characteristics.
Results: Pre-transplant HLA-DSA, anti-AT1R, and anti-MICA were detected in 37 (10.3%), 174 (48.5%), and 50 patients (13.9%), respectively. Post-transplant antibody-mediated rejection was associated with a pre-transplant HLA-DSA (+) status only. The development of microvascular inflammation (MVI) was associated with pre-transplant HLA-DSA (P=0.001) and anti-AT1R (P=0.036). Anti-AT1R (+) patients had significantly lower allograft survival compared with anti-AT1R (−) patients (P=0.042). Only pre-transplant anti-AT1R positivity was an independent risk factor for allograft failure (hazard ratio 4.824, confidence interval 1.017–24.888; P=0.038). MVI was the most common histological feature of allograft failure in patients with pre-transplant anti-AT1R.
Conclusions: Pre-transplant anti-AT1R is an important risk factor for allograft failure, which may be mediated by MVI induction in the allograft tissue.
Keywords: Angiotensin II type 1 receptor, Donor-specific anti-HLA antibody, Microvascular inflammation, Kidney transplantation



This Article

e-submission

Archives

Indexed/Covered by