Angiotensin II type 1 receptor antibody precipitating acute vascular rejection in kidney transplantation

Atypical non HLA antibodies are increasingly recognised as causes of immunological injury in allotransplantation. In this report we describe a non HLA sensitized male renal allograft recipient who developed acute vascular rejection on a “for cause” biopsy (Banff v2, g2, ptc 3) at day 4 post first renal allograft in the presence of elevated angiotensin II type 1 receptor antibodies (AT1R‐Ab level 14.1). The acute rejection was treated with pulse corticosteroid therapy, anti‐thymocyte globulin (ATG × 6), plasma exchange (1.5 plasma volume replacement x6) and oral candesartan. Serum creatinine improved and follow up biopsy confirmed resolution of rejection following treatment. AT1R‐Ab should be considered when rejection is diagnosed in the absence of HLA antibodies.