Anti-angiotensin II type 1 receptor and anti-endothelial cell antibodies: A cross-sectional analysis of pathological findings in allograft biopsies

Mary Carmelle Philogene, Serena Bagnasco, Edward S. Kraus, Robert A. Montgomery, Duska Dragun, Mary S. Leffell, Andrea A. Zachary, Annette M. Jackson

Research output: Contribution to journalArticlepeer-review

Abstract

Background. This is a cross-sectional study designed to evaluate the histologic characteristics of graft injury in the presence of anti-angiotensin II type 1 receptor antibody (AT1R-Ab) and anti-endothelial cell antibody (AECA). Methods. Non-HLA antibody testing was included in the posttransplant evaluation for 70 kidney recipients. Biopsies were performed for cause for 47 patients and as protocol for the remaining 23 patients. Biopsy-proven rejection was defined according to the Banff 2009-2013 criteria. AT1R-Ab was measured on an ELISA platform. Patients were divided into 3 groups based on AT1R-Ab levels (>17, 10-17, and <10 U/ml). AECA was evaluated using an endothelial cell crossmatch (ECXM) in patients whose HLA antibody level was insufficient to cause a positive flow cytometric crossmatch. Results. AT1R-Ab levels were higher in patients diagnosed with antibody mediated rejection compared to those with no rejection (P = 0.004). Glomerulitis (g) and peritubular capillaritis (ptc) scores were independently correlated with increased AT1R-Ab concentrations in the presence or absence of HLA-DSA (P = 0.007 and 0.03 for g scores; p = 0.005 and 0.03 for ptc scores). Patients with a positive ECXM had higher AT1R-Ab levels compared to those with a negative ECXM (P = 0.005). Microcirculation inflammation (MCI = g + ptc score) was higher in patients with a positive ECXM and with AT1R-Ab >17 U/ml, although this did not reach statistical significance (P = 0.07). Conclusions.The data show an association between non-HLA antibodies detected in the ECXM and AT1R ELISA andmicrovascular injury observed in antibodymediated rejection.

Original languageEnglish (US)
Pages (from-to)608-615
Number of pages8
JournalTransplantation
Volume101
Issue number3
DOIs
StatePublished - 2017

ASJC Scopus subject areas

  • Transplantation

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