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      Pretransplant sensitization against angiotensin II type 1 receptor is a risk factor for acute rejection and graft loss.

      American Journal of Transplantation

      Transplantation Immunology, Acute Disease, immunology, Receptor, Angiotensin, Type 1, Prospective Studies, Preoperative Care, Middle Aged, Male, Kidney Transplantation, surgery, blood, Kidney Diseases, Humans, HLA Antigens, Graft Survival, diagnosis, Graft Rejection, Follow-Up Studies, Female, Enzyme-Linked Immunosorbent Assay, Autoantibodies, Adult, Transplantation, Homologous

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          The angiotensin II type 1 receptor (AT1R) is an emerging target of functional non-HLA antibodies (Ab). We examined the potential of determining the degree of presensitization against AT1R as a risk factor for graft survival and acute rejection (AR). The study included 599 kidney recipients between 1998 and 2007. Serum samples were analyzed in a blinded fashion for anti-AT1R antibodies (AT1R-Abs) using a quantitative solid-phase assay. A threshold of AT1R-Ab levels was statistically determined at 10 U based on the time to graft failure. An extended Cox model determined risk factors for occurrence of graft failure and a first AR episode. AT1R-Abs >10 U were detected in 283 patients (47.2%) before transplantation. Patients who had a level of AT1R-Abs >10 U had a 2.6-fold higher risk of graft failure from 3 years posttransplantation onwards (p = 0.0005) and a 1.9-fold higher risk of experiencing an AR episode within the first 4 months of transplantation (p = 0.0393). Antibody-mediated rejection (AMR) accounted for 1/3 of AR, whereby 71.4% of them were associated with >10 U of pretransplant AT1R-Abs. Pretransplant anti-AT1R-Abs are an independent risk factor for long-term graft loss in association with a higher risk of early AR episodes. © Copyright 2013 The American Society of Transplantation and the American Society of Transplant Surgeons.

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