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Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán

2014, Número 3

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Rev Invest Clin 2014; 66 (3)


Anticuerpos contra el receptor 1 de angiotensina II pretrasplante: ¿un factor de riesgo para la disminución de la función del injerto en el periodo postrasplante temprano?

Hernández-Méndez EA, Arreola-Guerra JM, Morales-Buenrostro LE, Ramírez JB, Calleja S, Castelán N, Salcedo I, Vilatobá M, Contreras AG, Gabilondo B, Granados J, Alberú J

Idioma: Español
Referencias bibliográficas: 36
Paginas: 218-224
Archivo PDF: 150.00 Kb.


RESUMEN

Los anticuerpos dirigidos contra el receptor 1 de angiotensina II (anti-AT1R) han sido asociados a una supervivencia significativamente menor del injerto y a un mayor riesgo de rechazo agudo en receptores de trasplante renal. El objetivo de este estudio fue evaluar la función renal y los episodios de rechazo agudo confirmados por biopsia (RACB) durante el primer año de evolución postrasplante (PT) en receptores de trasplante renal (RTR) adultos, efectuados entre 03/2009 y 08/2012. El suero pretrasplante fue analizado para detectar la presencia de anti-AT1R (ELISA) y para anticuerpos HLA donante específico (ADE-HLA) (Luminex). Se conformaron tres grupos para el análisis: presencia exclusiva de anti- AT1R (n = 13); presencia exclusiva de ADE-HLA (n = 8); y ausencia de anti-AT1R y de ADE-HLA (n = 90). No se observaron diferencias en las características clínicas entre los grupos. Un porcentaje mayor, no significativo, de RACB fue observado en el grupo anti-AT1R positivo. Los RTR con anti- AT1R tuvieron una menor tasa de filtrado glomerular estimada (TFGe) promedio (20 mL/min/1.73m2) a 12 meses PT cuando se compararon con los RTR sin anticuerpos. Esta diferencia significativa en la TFGe se observó desde el primer mes PT. El análisis multivariado mostró cuatro factores independiente y significativamente asociados con TFGe a 12 meses PT: RACB (-18.7, 95% IC -28.2 a -9.26, p ‹ 0.001), anti-AT1R (-10.51, IC -20.9 a -0.095, p = 0.048), edad del donante (-0.42, IC -0.75 a -0.103, p = 0.010) y edad del receptor (-0.36, IC -0.67 a -0.048, p = 0.024). En este estudio la presencia de anti-AT1R en suero pretrasplante de RTR fue un factor de riesgo independiente y significativo para TFGe reducida a 12 meses PT. Este hallazgo requiere ser confirmado en una población más numerosa de RTR.


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