Immunosuppression as a Risk Factor for De Novo Angiotensin II Type Receptor Antibodies Development after Kidney Transplantation

Bogdan Marian Sorohan; Ioanel Sinescu; Dorina Tacu; Cristina Bucșa; Corina Țincu; Bogdan Obrișcă; Andreea Berechet; Ileana Constantinescu; Ion Mărunțelu; Gener Ismail; Cătălin Baston

doi:10.3390/jcm10225390

Immunosuppression as a Risk Factor for De Novo Angiotensin II Type Receptor Antibodies Development after Kidney Transplantation

J Clin Med. 2021 Nov 18;10(22):5390. doi: 10.3390/jcm10225390.

Authors

Bogdan Marian Sorohan^{1

2}, Ioanel Sinescu^{1

3}, Dorina Tacu³, Cristina Bucșa³, Corina Țincu³, Bogdan Obrișcă^{1

2}, Andreea Berechet², Ileana Constantinescu^{1

4}, Ion Mărunțelu⁴, Gener Ismail^{1

2}, Cătălin Baston^{1

3}

Affiliations

¹ Department of General Medicine, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania.
² Department of Nephrology, Fundeni Clinical Institute, 022328 Bucharest, Romania.
³ Center for Uronephrology and Kidney Transplantation, Fundeni Clinical Institute, 022328 Bucharest, Romania.
⁴ Department of Immunogenetics, Fundeni Clinical Institute, 022328 Bucharest, Romania.

Abstract

(1) Background: Angiotensin II type I receptor antibodies (AT1R-Ab) represent a topic of interest in kidney transplantation (KT). Data regarding the risk factors associated with de novo AT1R-Ab development are lacking. Our goal was to identify the incidence of de novo AT1R-Ab at 1 year after KT and to evaluate the risk factors associated with their formation. (2) Methods: We conducted a prospective cohort study on 56 adult patients, transplanted between 2018 and 2019. Recipient, donor, transplant, treatment, and complications data were assessed. A threshold of >10 U/mL was used for AT1R-Ab detection. (3) Results: De novo AT1R-Ab were observed in 12 out of 56 KT recipients (21.4%). The median value AT1R-Ab in the study cohort was 8.5 U/mL (inter quartile range: 6.8-10.4) and 15.6 U/mL (10.8-19.8) in the positive group. By multivariate logistic regression analysis, induction immunosuppression with anti-thymocyte globulin (OR = 7.20, 95% CI: 1.30-39.65, p = 0.02), maintenance immunosuppression with immediate-release tacrolimus (OR = 6.20, 95% CI: 1.16-41.51, p = 0.03), and mean tacrolimus trough level (OR = 2.36, 95% CI: 1.14-4.85, p = 0.01) were independent risk factors for de novo AT1R-Ab at 1 year after KT. (4) Conclusions: De novo AT1R-Ab development at 1 year after KT is significantly influenced by the type of induction and maintenance immunosuppression.

Keywords: ATG; angiotensin II type 1 receptor antibody; de novo; immunosuppression; induction; kidney transplant; maintenance; risk factor; tacrolimus.