Angiotensin II type 1 receptor antibody precipitating acute vascular rejection in kidney transplantation

Abstract

ABSTRACT:Atypical non HLA antibodies are increasingly recognised as causes of immunological injury in allotransplantation. In this report we describe a non HLA sensitized male renal allograft recipient who developed acute vascular rejection on a "for cause" biopsy (Banff v2, g2, ptc 3) at day 4 post first renal allograft in the presence of elevated angiotensin II type 1 receptor antibodies (AT1R-Ab level 14.1). The acute rejection was treated with pulse corticosteroid therapy, anti-thymocyte globulin (ATG × 6), plasma exchange (1.5 plasma volume replacement x6) and oral candesartan. Serum creatinine improved and follow up biopsy confirmed resolution of rejection following treatment. AT1R-Ab should be considered when rejection is diagnosed in the absence of HLA antibodies.Humoural activity against HLA antigens is well recognized as a risk factor for rejection in kidney transplantation; however, in a significant number of cases, early antibody-mediated rejection occurs in the absence of detectable HLA antibodies.

Detection of Angiotensin II type I‐receptor antibodies in transplant glomerulopathy

“…Our data show a high prevalence of AT 1 R‐Ab in subjects with TG. Indeed, the frequency of PT‐Ab positive patients was 16.5%, while the frequency of patients with PT‐Ab within the “at risk” range was 51.5%, according to previous studies describing a variability from 17% to 47% . On the other hand, we found lower frequency in AT 1 R‐Ab positivity (11.5%) or within the “at risk” range (27.4%) at the time of biopsy.…”

Is pre-transplant sensitization against angiotensin II type 1 receptor still a risk factor of graft and patient outcome in kidney transplantation in the anti-HLA Luminex era? A retrospective study

“…Dragun et al [8,13] have shown for the first time their involvement in patients presenting acute rejection episodes (ARE) with severe hypertensive crisis. Since this first observation, the correlation of anti-AT1R antibodies and acute rejection and/or graft failure has become more debated in kidney transplantation sometimes due to a lack of power of studies [15][16][17][18][19][20][21][22][23][24]. In 2013, we showed on a large monocentric cohort (n = 599) of French kidney recipients that patients who displayed a pretransplant AT1R-Ab level above 10 U/ml had higher risk of acute rejection episodes within the first month following transplantation and graft failure beyond 3 years post-transplantation [25,26].…”

Efficacy of therapeutic plasma exchange on angiotensin II type‐1 receptor antibodies on two kidney transplant recipients

“…There are some reports in which TPE was used to treat AMR in kidney transplant recipients with AT1RAbs. Jobert et al reported a case of AMR in a kidney transplant recipient with AT1RAb, who received 6 TPE procedures with 1.5 plasma volume exchange . Fuss et al used 3–11 TPE procedure to treat 6 kidney AMR patients with AT1RAbs .…”

“…Jobert et al reported a case of AMR in a kidney transplant recipient with AT1RAb, who received 6 TPE procedures with 1.5 plasma volume exchange. 15 Fuss et al used 3-11 TPE procedure to treat 6 kidney AMR patients with AT1RAbs. 16 Lee et al 17 treated 11 cases of AT1RAb associated AMR with a combination of TPE and IVIG, sometimes followed by rituximab (9/12), antithymocyte globulin (5/12), or bortezomib (1/12).…”