Angiotensin II Type 1 receptor antibodies are associated with inflammatory cytokines and poor clinical outcomes in pediatric kidney transplantation.

Autor:	Pearl MH; Division of Pediatric Nephrology, UCLA Mattel Children's Hospital, University of California, Los Angeles, Los Angeles, California, USA. Electronic address: mpearl@mednet.ucla.edu., Zhang Q; Department of Pathology and Laboratory Medicine, University of California, Los Angeles, Los Angeles, California, USA., Palma Diaz MF; Department of Pathology and Laboratory Medicine, University of California, Los Angeles, Los Angeles, California, USA., Grotts J; Department of Medicine Statistics Core, University of California, Los Angeles, Los Angeles, California, USA., Rossetti M; Department of Pathology and Laboratory Medicine, University of California, Los Angeles, Los Angeles, California, USA., Elashoff D; Department of Medicine Statistics Core, University of California, Los Angeles, Los Angeles, California, USA., Gjertson DW; Department of Pathology and Laboratory Medicine, University of California, Los Angeles, Los Angeles, California, USA., Weng P; Division of Pediatric Nephrology, UCLA Mattel Children's Hospital, University of California, Los Angeles, Los Angeles, California, USA., Reed EF; Department of Pathology and Laboratory Medicine, University of California, Los Angeles, Los Angeles, California, USA., Tsai Chambers E; Division of Pediatric Nephrology, UCLA Mattel Children's Hospital, University of California, Los Angeles, Los Angeles, California, USA; Division of Pediatric Nephrology, Duke University Medical Center, Durham, North Carolina, USA.
Jazyk:	angličtina
Zdroj:	Kidney international [Kidney Int] 2018 Jan; Vol. 93 (1), pp. 260-269. Date of Electronic Publication: 2017 Sep 18.
DOI:	10.1016/j.kint.2017.06.034
Abstrakt:	Angiotensin II type 1 receptor (AT1R) antibody has been linked to poor allograft outcomes in adult kidney transplantation. However, its clinical consequences in children are unknown. To study this, we examined the relationship of AT1R antibody with clinical outcomes, biopsy findings, inflammatory cytokines, and HLA donor-specific antibodies (DSA) in a cohort of pediatric renal transplant recipients. Sixty-five patients were longitudinally monitored for AT1R antibody, HLA DSA, IL-8, TNF-α, IL-1β, IFN-γ, IL-17, and IL-6, renal dysfunction, hypertension, rejection, and allograft loss during the first two years post transplantation. AT1R antibody was positive in 38 of the 65 of children but was not associated with HLA DSA. AT1R antibody was associated with renal allograft loss (odds ratio of 13.1 [95% confidence interval 1.48-1728]), the presence of glomerulitis or arteritis, and significantly higher TNF-α, IL-1β, and IL-8 levels, but not rejection or hypertension. AT1R antibody was associated with significantly greater declines in eGFR in patients both with and without rejection. Furthermore, in patients without rejection, AT1R antibody was a significant risk factor for worsening eGFR over the two-year follow-up period. Thus, AT1R antibody is associated with vascular inflammation in the allograft, progressive decline in eGFR, and allograft loss. AT1R antibody and inflammatory cytokines may identify those at risk for renal vascular inflammation and lead to early biopsy and intervention in pediatric kidney transplantation. (Copyright © 2017 International Society of Nephrology. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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