Background: Anti-endothelial cell antibodies (AECA) have been associated with graft dysfunction and rejection, but lack of scalable, cheap testing has hindered routine screening. Indirect immunofluorescence on human umbilical vein endothelial cells (HUVEC) aims to fill this niche, and a high incidence of severe multiple rejections has been reported in a large study of deceased-donor kidney transplant recipients.
Methods: We retrospectively studied 119 kidney transplants and 21 pancreas transplants consecutively performed in 128 recipients at our Centre.
Results: 13% showed positive pretransplant AECA. Of them, 47% showed negativization of AECA at various posttransplant times. At a median follow-up of 14 months (range : 6-24), patients with positive pretransplant AECA showed a higher risk of biopsy-proven acute cell-mediated pancreas rejection (OR = 24; P = 0.02); post-transplant persistence of AECA correlated with an even higher risk of pancreas rejection (OR = 78 ; P = 0.01). No correlation between pretransplant AECA and risk of kidney rejection or graft loss was found. De novo AECA developed in 4% of all patients, but did not correlate with any transplant-related event.
Conclusion: Our study demonstrates a lack of importance of pretransplant and de novo AECA screening in kidney transplantation. Larger studies on pancreas transplantation will be necessary to confirm the relevance in such setting.
Author(s): Daniele Focosi, Guido Ricchiuti, Chiara Biagini, Monica De Donno, Niccola Funel, Piero Marchetti , and Ugo Boggi