Xu Q, et al. - In view of previous studies suggesting detrimental effects of angiotensin II type I receptor (AT1R) agonistic autoantibodies (AT1R-AA) in primary liver transplantation, researchers assessed a retrospective cohort of 94 patients who received a second liver transplant for AT1R-AA prevalence and effects. The 48 patients who lost their liver grafts exhibited higher concentrations of preformed AT1R-AA before transplantation than the 46 patients whose grafts survived. About half (48/94, 51.1%) of the patients were positive for AT1R-AA > 17 U/mL before the second liver transplantation. Patients with strong positive AT1R-AA (defined as > 40 U/mL) had significantly worse graft survival than those with AT1R-AA < 40 U/mL in Kaplan-Meier analysis. Both AT1R-AA > 40 U/mL (HR = 1.999 [1.085-3.682]) and increased concentrations of AT1R-AA (HR = 1.003 [1.001-1.006] per incremental U/mL) were significantly correlated with raised risk for graft loss in multivariate Cox models that incorporated confounders such as gender and age. In conclusion, AT1R-AA presence is connected with inferior long-term outcomes of the second graft.