Isolated De Novo Antiendothelial Cell Antibodies and Kidney Transplant Rejection

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• 作者：Elena Sá ; nchez-Zapardiel ; MSc¹ ; ^{eszapardiel@gmail.com" class="auth_mail" title="E-mail the corresponding author} ; Esther Mancebo ; PhD¹ ; ² ; Marí ; a Dí ; az-Ordo&ntilde ; ez ; BSc³ ; Lucí ; a de Jorge-Huerta ; BSc³ ; Lara Ruiz-Martí ; nez ; BSc³ ; Antonio Serrano ; MD ; PhD¹ ; ² ; ⁴ ; Marí ; a J. Castro-Panete ; PhD¹ ; ² ; Alberto Utrero-Rico ; BSc² ; ³ ; Amado de André ; s ; MD ; PhD⁵ ; José ; M. Morales ; MD ; PhD² ; ⁵ ; Sara Domí ; nguez-Rodrí ; guez ; BSc³ ; Estela Paz-Artal ; MD ; PhD¹ ; ² ; ³ ; ⁴
• 关键词：Anti-endothelial cell antibodies (AECAs) ; de novo antibodies ; allograft rejection ; immunofluorescence patterns ; kidney transplantation ; acute rejection ; allograft loss ; mortality
• 刊名：American Journal of Kidney Diseases
• 出版年：2016
• 出版时间：December 2016
• 年：2016
• 卷：68
• 期：6
• 页码：933-943
• 全文大小：848 K

文摘

Studies analyzing the role of antiendothelial cell antibodies (AECAs) in large series of kidney transplant recipients are scarce, and HLA, MHC (major histocompatibility complex) class I−related chain A (MICA), and angiotensin II type 1 receptor have not been formally excluded as targets.

Study Design

Retrospective study of a cohort of kidney transplant recipients.

Setting & Participants

324 kidney transplant recipients who were negative for anti-HLA, anti-MICA, and anti–angiotensin II type 1 receptor antibodies were tested for AECAs in pre- and posttransplantation serum samples.

Predictors

AECA-positive (preformed [pre⁺/post⁺] vs de novo [pre⁻/post⁺]) versus AECA-negative (pre⁻/post⁻) before or after transplantation.

Outcomes

Patient mortality, transplant loss, and acute rejection events.

Results

66 (20%) patients were AECA positive (39 [12%] preformed, 27 [8%] de novo) and 258 (80%) were AECA negative. During a follow-up of 10 years, 7 (18%) AECA pre⁺/post⁺ patients had rejections compared with 14 (52%) AECA pre⁻/post⁺ and 57 (22%) AECA pre⁻/post⁻ recipients (OR, 3.80; P = 0.001). AECA pre⁻/post⁺ status emerged as an independent risk factor for transplant rejection compared to the AECA pre⁻/post⁻ group (OR, 5.17; P < 0.001). However, AECA pre⁺/post⁺ and AECA pre⁻/post⁺ patients did not show higher risk for either patient death (ORs of 1.49 [P = 0.7] and 1.06 [P = 0.9], respectively) or transplant loss (ORs of 1.22 and 0.86, respectively; P for both = 0.8) compared to the AECA pre⁻/post⁻ population.

Limitations

Retrospective study. Posttransplantation sera were collected before or after rejection, entailing a nearly cross-sectional relationship between the exposure and outcome. Lack of identification of precise antigens for AECAs.

Conclusions

De novo AECAs may be associated with rejection. These antibodies might serve as biomarkers of endothelium damage in kidney transplant recipients.