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Abstract: PO2198

Immunosuppression Could Influence De Novo Angiotensin II Type Receptor Antibodies Development Early After Kidney Transplantation

Session Information

Category: Transplantation

  • 1902 Transplantation: Clinical

Authors

  • Sorohan, Bogdan Marian, Universitatea de Medicina si Farmacie Carol Davila, Bucharest, Bucharest, Romania
  • Berechet, Andreea Ioana, Institutul Clinic Fundeni, Bucharest, Bucharest, Romania
  • Bucsa, Cristina, Institutul Clinic Fundeni, Bucharest, Bucharest, Romania
  • Tincu, Corina, Institutul Clinic Fundeni, Bucharest, Bucharest, Romania
  • Obrisca, Bogdan, Universitatea de Medicina si Farmacie Carol Davila, Bucharest, Bucharest, Romania
  • Ismail, Gener, Universitatea de Medicina si Farmacie Carol Davila, Bucharest, Bucharest, Romania
Background

Angiotensin II type I receptor antibodies (AT1R-Ab) are non-HLA autoAb associated with graft rejection and detrimental effects on graft function in kidney transplantation (KT). Nevertheless, the data regarding risk factors associated with AT1R-Ab development is scanty. To our knowledge, immunosuppression (IS) has not yet been reported as a potential risk factor. We sought to evaluate the incidence of de novo AT1R-Ab at 1 year after KT and risk factors associated with their formation.

Methods

We performed a prospective study on 58 KT recipients, transplanted between October 2018 and October 2019, who were followed for 1 year. Exclusion criteria: age <18 years and preformed AT1R-Ab. AT1R-Ab were evaluated at 1 year after KT using an ELISA technique and the cut-off value for detection was >10 U/ml. Logistic regression analysis was used to identify risk factors associated with AT1R-Ab formation.

Results

Twelve out of 58 patients (20.6%) had de novo AT1R-Ab at 1 year of follow-up. Mean age of the study cohort was 40.8±10.5 years, 60.3% were males and 17.2% had a preemptive KT. Glomerular diseases was the main cause for CKD (27.6%). Donors mean age was 48.6±15.6 years, 62.1% were cadaveric donors and 31% of patients had ≥4 mismatches. Monoclonal Ab directed against IL-2 receptor (84.5%) was the main induction IS used. Immediate-release tacrolimus (TAC) was used in 53.4% and mycophenolate sodium was preferred in 89.7% of cases. Patients with de novo AT1R-Ab had a significantly decreased BMI (21.4±1.8 vs 23.2±2.9 kg/m2, p=0.04), received significantly more frequently IS with rabbit globulin anti-thymocyte (rATG) (41.7 vs 8.7%, p=0.01), immediate-release TAC (83.3 vs 45.7%, p=0.01) and had a significantly higher mean TAC level at 3 months after KT (13.8±5.6 vs 11.4± 3ng/ml, p=0.04). By multivariate logistic regression we found that rATG was an independent risk factor for de novo AT1R-Ab development (OR= 5.62; 95%CI: 1.11- 28.34, p=0.03) and immediate-release TAC had a trend of association with Ab (OR= 5.02; 95%CI: 0.93- 27.06, p=0.03) at 1 year after KT.

Conclusion

The incidence of de novo AT1R-Ab was 20.6% and rATG induction IS was an independent risk factor for Ab development at 1 year after KT. Our results suggest that IS could influence de novo AT1R-Ab formation.