Angiotensin II type I receptor agonistic autoantibodies are associated with poor allograft survival in liver retransplantation. Issue 1 (6th September 2019)

• Record Type: Journal Article
• Authors: Xu, Qingyong; McAlister, Vivian C.; Leckie, Steve; House, Andrew A.; Skaro, Anton; Marotta, Paul
• Is Part Of: American journal of transplantation. Volume 20:Issue 1(2020)
• Page Start: 282
• Page End: 288
• Publication Date: 2019-09-06
• Subjects: autoantibody -- clinical research/practice -- immunobiology -- liver allograft function/dysfunction -- liver transplantation/hepatology -- retransplantation -- translational research/science; Transplantation of organs, tissues, etc -- Periodicals; 617.95
• DOI: 10.1111/ajt.15571
• Languages: English
• ISSNs: 1600-6135

Abstract

Abstract : Angiotensin II type I receptor (AT1R) agonistic autoantibodies (AT1R‐AA) are detrimental to kidney transplantation. Early studies suggested a similar negative effect in primary liver transplantation. Here, we studied AT1R‐AA in a retrospective cohort of 94 patients who received a second liver transplant to determine their prevalence and effects. The concentrations of preformed AT1R‐AA before transplantation were higher ( P = .019) in the 48 patients who lost their liver grafts than in the 46 patients whose grafts survived. About half (48/94, 51.1%) of the patients were positive for AT1R‐AA >17 U/mL before the second liver transplantation. In 22 (23.4%) patients, strong positive AT1R‐AA (defined as >40 U/mL) were detected, of whom 16 (72.7%) patients lost their grafts. Based on Kaplan‐Meier analysis, patients with strong positive AT1R‐AA had significantly worse graft survival than those with AT1R‐AA <40 U/mL ( P = .035). In multivariate Cox models that included confounders such as sex and age, either AT1R‐AA >40 U/mL (HR = 1.999 [1.085‐3.682], P = .026) or increased concentrations of AT1R‐AA (HR = 1.003 [1.001‐1.006] per incremental U/mL, P = .019) were significantly associated with elevated risk for graft loss. In conclusion, our data indicate that there is a high prevalence of AT1R‐AA in candidates for second liver transplantation and that their presence is associated with inferior long‐term outcomes of the second graft. Abstract : In this retrospective study, Xu and colleagues demonstrate that agonistic autoantibodies to the angiotensin II type I receptor are common before second liver transplantation and, at high concentration, are associated with inferior survival of the second graft.