Prevalence of AT1R antibody (AT1R-Ab) among Malaysian multi-ethnic population

Jalalonmuhali M 1 , Caroll R 2 , Deayton S 3 , Emery T 4 , Humphreys I 5 , Lim SJ 6 Show all authors , Lim SK 7 , Coates T 8

Affiliations 

  • 1 Central Northern Adelaide Renal and Transplant Services, Adelaide, 5000 Australia; Division of Nephrology, Department of Medicine, University Malaya Medical Centre, Kuala Lumpur, 59100 Malaysia. Electronic address: maisarahj@ummc.edu.my
  • 2 Central Northern Adelaide Renal and Transplant Services, Adelaide, 5000 Australia; South Australian Transplantation and Immunogenetics Laboratory (SATIS), Australian Red Cross Blood Service, North Adelaide, 5006 Australia. Electronic address: robert.carroll@sa.gov.au
  • 3 South Australian Transplantation and Immunogenetics Laboratory (SATIS), Australian Red Cross Blood Service, North Adelaide, 5006 Australia. Electronic address: sdeayton@redcrossblood.org.au
  • 4 South Australian Transplantation and Immunogenetics Laboratory (SATIS), Australian Red Cross Blood Service, North Adelaide, 5006 Australia. Electronic address: temery@redcrossblood.org.au
  • 5 South Australian Transplantation and Immunogenetics Laboratory (SATIS), Australian Red Cross Blood Service, North Adelaide, 5006 Australia. Electronic address: IHumphreys@redcrossblood.org.au
  • 6 Division of Nephrology, Department of Medicine, University Malaya Medical Centre, Kuala Lumpur, 59100 Malaysia
  • 7 Division of Nephrology, Department of Medicine, University Malaya Medical Centre, Kuala Lumpur, 59100 Malaysia. Electronic address: limsk@ummc.edu.my
  • 8 Central Northern Adelaide Renal and Transplant Services, Adelaide, 5000 Australia; South Australian Transplantation and Immunogenetics Laboratory (SATIS), Australian Red Cross Blood Service, North Adelaide, 5006 Australia. Electronic address: toby.coates@sa.gov.au
Hum Immunol, 2020 Dec;81(12):679-684.
PMID: 32736900 DOI: 10.1016/j.humimm.2020.07.005

Abstract

BACKGROUND: Angiotensin II type 1 receptor antibody (AT1R-Ab) is a non-HLA antibody that has been reported to cause antibody-mediated rejection and graft loss in kidney transplantation. The prevalence of positive AT1R-Ab varies between 8% and 18% in different regions. Thus, this study aims to determine the prevalence of AT1R-Ab among the Malaysian population.

METHODOLOGY: All sera for AT1R-Ab were collected at the University Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia. The sera were centrifuged and kept refrigerated at -80 °C before being transported to the South Australian Transplantation and Immunogenetics Laboratory (SATIS). Enzyme-linked immunosorbent assay kit (One Lambda) was used for the detection of AT1R-Ab, and it was performed according to the manufacturer's instructions. The level of >17.1 U/mL was considered to be AT1R-Ab positive; 10.0-17.1 U/mL at risk, and <10.0 U/mL negative.

RESULTS: A total of 115 samples were collected from 99 patients pre and post-kidney transplant recipients. From the pre-transplant sera (n = 68) 17.7% were positive, 35.3% were at risk and 47.0% were negative. The positive AT1R-Ab cohort were relatively younger, with a mean age of 34.7 ± 8.3 years old and statistically significant, with a p-value of 0.028. Among the sera that were tested positive, 19.0% were from the Chinese ethnicity, 6.7% from Malay and 16.7% from Indian. There was no difference in the rejection episodes, persistent or de novo HLA-DSA, and graft function between the group (AT1R-Ab negative vs AT1R-Ab at risk and positive) and the results were consistent in a model adjusted for all potential confounders.

CONCLUSION: The prevalence of positive (>17.1 U/mL) pre-transplant AT1R-Ab was 17.7% and 35.3% were at risk (10.0-17.1 U/mL) in our pre-transplant cohort.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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