The Presence of Pretransplant Antiphospholipid Antibodies IgA Anti-β-2-Glycoprotein I as a Predictor of Graft Thrombosis After Renal Transplantation.

Autor:	Morales JM; 1 Department of Immunology, Instituto de Investigación Hospital Universitario, Madrid, Spain. 2 Department of Nephrology, Instituto de Investigación Hospital Universitario, Madrid, Spain. 3 Department of Urology, Instituto de Investigación Hospital Universitario, Madrid, Spain. 4 Department of Pathology, Instituto de Investigación Hospital Universitario, Madrid, Spain. 5 Immunology Section, Universidad San Pablo-CEU, Madrid, Spain. 6 Facultad de Medicina, Universidad Complutense, Madrid, Spain., Serrano M, Martínez-Flores JA, Pérez D, Castro MJ, Sánchez E, García F, Rodríguez-Antolín A, Alonso M, Gutierrez E, Morales E, Praga M, González E, Andrés A, Paz-Artal E, Martínez MA, Serrano A
Jazyk:	angličtina
Zdroj:	Transplantation [Transplantation] 2017 Mar; Vol. 101 (3), pp. 597-607.
DOI:	10.1097/TP.0000000000001199
Abstrakt:	Background: Vessel thrombosis is a severe complication after renal transplantation. Antibodies anti-β-2 glycoprotein-I of IgA isotype (IgA-aB2GP1) have been linked to thrombotic events and mortality in hemodialysis patients. Methods: All kidney transplanted patients from 2000 to 2011 (n = 1375) in our hospital were followed up for 2 years, evaluating 3 time periods. Results: At transplantation, 401 patients were positive for IgA-aB2GPI (29.2%, group 1), and the remaining patients were negative (group 2). Graft loss at 6 months posttransplantation was higher in group 1 (18% vs 7.2%; P < 0.001). The most frequent cause of early graft loss was vessel thrombosis, especially in group 1 (12.2% vs 2.6% of patients; P < 0.001). In fact, vessel thrombosis was the most important cause of graft loss in the 3 time periods, irrespective of demographic changes and introduction of transplantation with asystolic donors.Notably, IgA-aB2GP1 was an independent risk factor for graft thrombosis (odds ratio, 5.047; P < 0.001). Furthermore, the presence of IgA-aB2GP1 was associated with early graft loss and delayed graft function. Mortality at 24 months was also higher in group 1. Conclusions: In conclusion, pretransplant IgA-aB2GP1 was the main risk factor for graft thrombosis and early graft loss. Further research should be made on whether anticoagulation in antibody-positive patients could ameliorate this catastrophic complication.
Databáze:	MEDLINE
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