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Abstract: TH-PO172

Autoantibodies to Apolipoprotein A-1 as Independent Predictors of Cardiovascular Mortality in Renal Transplant Recipients

Session Information

Category: Transplantation

  • 1802 Transplantation: Clinical

Authors

  • Anderson, Josephine, University Medical Centre Groningen, Groningen, Netherlands
  • Pagano, Sabrina, Geneva University Hospital, Geneva, Switzerland
  • Annema, Wijtske, Geneva University Hospital, Geneva, Switzerland
  • Bakker, Stephan J.L., University Medical Center Groningen, Groningen, Netherlands
  • Vuilleumier, Nicolas, Geneva University Hospital, Geneva, Switzerland
  • Tietge, Uwe Jf, University Medical Center Groningen, Groningen, Netherlands
Background

The aim of this study was to determine i) the prognostic value of autoantibodies against apoA-1 (anti-apoA-1 IgG) for incidence of cardiovascular disease (CVD) specific mortality, all-cause mortality and graft failure in renal transplant recipients (RTR), patients known to have a high CVD burden only partly explained by traditional CVD risk factors, and ii) to delineate the relationship of anti-apoA-1 IgG with HDL functionality.

Methods

462 prospectively included RTR were followed for 7.0 years. Baseline anti-apoA-1 IgG were determined and associations with incidence of CVD mortality (n=48), all-cause mortality (n=92) and graft failure (n=39) were tested.

Results

HDL functionality assessed in vitro by measuring anti-oxidative and cholesterol efflux capacity was not associated with anti-apoA-1 IgG levels. Kaplan–Meier analyses demonstrated significant associations of anti-apoA-1 IgG with CVD mortality (log rank test among tertiles: P=0.048). Adjusted Cox regression analysis showed that for each standard deviation increase of log transformed anti-apoA-1 IgG values, there was a 4-fold increase (hazard ratio [HR]: 4.00; 95% confidence interval [95%CI]:1.32-12.11; p=0.01) in risk for CVD mortality and a more than 2-fold increase for all-cause mortality (HR:2.69, 95%CI:1.25-5.83; P=0.01), independent of CVD risk factors, renal and HDL function. The association with all-cause mortality disappeared after excluding cases of CVD specific mortality. The sensitivity, specificity, positive predictive value, and negative predictive value of anti-apoA-1 positivity for CVD mortality were 18.0%, 89.3%, 17.0%, and 90.0%, respectively.

Conclusion

In conclusion, this prospective study demonstrates that in RTR, anti-apoA-1 IgG are independent predictors of CVD mortality. In RTR, anti-apoA-1 IgG are not associated with HDL functionality.