Pretransplant angiotensin II type 1-receptor antibodies are a risk factor for earlier detection of de novo HLA donor-specific antibodies.

BACKGROUND: Angiotensin II type 1 receptor antibodies (AT1Rabs) have been associated with significantly reduced graft survival. Earlier graft loss has been observed in patients who had pretransplant AT1Rabs and posttransplant donor-specific antibodies (DSA). METHODS: The main goal of this retrospective cohort study was to examine the association between AT1Rabs and the time period to detection of de novo human leukocyte antigen (HLA-DSA) posttransplantation in living donor kidney transplant recipients (KTR). The analysis included 141 KTRs. Pretransplant frozen serum samples were tested for AT1Rabs by ELISA and HLA-DSA by SAB (Luminex) at both the pre- and post-KT time points. RESULTS: The median AT1Rab level was 9.13 U (interquartile range 5.22-14.33). After a mean follow-up period of 3.55 years, 48 patients were found to harbour de novo HLA-DSAs. The presence of AT1Rabs [hazard ratio (HR) 1.009, 95% confidence interval (CI) 1.002-1.01, P = 0.010], male-to-male transplantation (HR 2.57, 95% CI 1.42-4.67, P = 0.002) and antecedent borderline changes or acute cellular rejection (ACR) (HR 2.47, 95% CI 1.29-4.75, P = 0.006) were significantly associated with de novo DSA detection. A dose-dependent association between AT1Rab levels (<10 U, 10.1-16.9 U, 17-29.9 U and >30 U) and de novo DSA detection was observed (log-rank P = 0.0031). After multivariate analysis of AT1Rab levels (continuous variable), AT1Rabs >30 U, male-to-male transplantation, donor age, higher class I percentage of Panel Reactive Antibody and antecedent borderline changes or ACR remained as independent significant risk factors for the detection of de novo DSAs. CONCLUSIONS: The findings suggest that higher levels of pretransplant circulating antibodies against AT1R (>30 U) in kidney graft recipients constitute an independent risk factor for earlier de novo HLA-DSA detection during the posttransplant period.

"Expanding the limits". Three-year follow-up of renal transplant recipients from a deceased donor with creatinine greater than 5 mg/dl. Report of three cases.

Due the shortage of organ donors and the increase in the waiting list of kidney transplant recipients (KTR), alternative strategies have been considered with the aim of increasing the number of organs available. The use of kidneys from donors with acute renal failure and elevated serum creatinine has been considered as a way to increase the number of donors. The objective of this work is to report the 3-year follow-up of three KTR patients of a deceased donor with serum creatinine greater than or equal to 5 mg/dL.

Ante la escasez de donadores de órganos y el incremento en la lista de espera de receptores de trasplante renal (RTR) se han considerado medidas alternativas con el objetivo de aumentar el número de órganos disponibles. El uso de riñones de donadores con insuficiencia renal aguda y creatinina sérica terminal elevada se ha considerado un camino para incrementar el número de donadores. El objetivo de este trabajo es notificar el seguimiento a tres años de tres pacientes RTR de donador fallecido con creatinina sérica ≥ 5 mg/dl.