Antiphospholipid antibodies and renal transplant: A systematic review and meta-analysis

Merashli, Mira; Bucci, Tommaso; Gentile, Fabrizio; Alves, José Delgado

doi:10.1016/j.semarthrit.2018.10.016

Cited by 12 publications

(8 citation statements)

References 45 publications

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“…Accordingly, the low heterogeneity displayed in the relation between LA and fistula occlusion might imply that the fluid phase coagulation assays detect a wider repertoire of aPL against native and oxidized lipid epitopes than aPL detected by solid‐phase immunoassays. The cessation of oxidative stress postrenal transplant may decrease or prevent the generation of these oxidized lipid epitopes, 64 which in turn may account for the disappearance of LA after the allograft, as previously shown 65 …”

Section: Discussionmentioning

confidence: 99%

Antiphospholipid antibodies in end‐stage renal disease: A systematic review and meta‐analysis

Merashli

Bucci

Pastori

et al. 2020

Hemodialysis International

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Introduction The relationship between autoimmune hemolytic anemia and antiphospholipid antibodies (aPL) and/or antiphospholipid syndrome has never been systematically addressed. Methods Systematic review of EMBASE and PubMed databases performed according to PRISMA guidelines from inception to March 2020; meta‐analysis performed by Peto's odds ratio for rare events. Findings Forty‐five studies with different outcomes met the inclusion/exclusion criteria. The pooled prevalence (PP) of IgG anticardiolipin antibodies (aCL) positivity was greater in end‐stage renal disease (ESRD) than controls (20.2% vs. 2.6%, P = 0.001, I2 >80%; I2 = heterogeneity), particularly in hemodialysis patients (18.3% vs. 8%, I2 = 0%). The PP of lupus anticoagulant was greater in ESRD than controls (8.7% vs. 0.2%, P < 0.0001, I2 = 0%). The standardized mean difference of IgG aCL favored ESRD rather than controls (P < 0.0001, I2 =97%). The PP of fistula occlusion was greater in IgG aCL‐positive patients than negative patients (39% vs. 27%, I2 =97%); the PP of IgG aCL positivity was greater in patients with fistula occlusion than without fistula occlusion (26.9% vs. 23.2%, P = 0.01, I2 =72%); the same applied to the PP of lupus anticoagulant positivity (23% vs. 0.3%, P < 0.0001, I2 = 0%). The standardized mean difference of IgG aCL favored fistula occlusion (P = 0.004, I2 = 91%). Discussion Lupus anticoagulant relates to ESRD regardless of management whereas IgG aCL relates specifically to ESRD on hemodialysis, but only lupus anticoagulant associates with fistula occlusion. The expression of aPL as patients positive for aPL rather than as titers precludes further assumptions on the relationship.

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Section: Discussionmentioning

confidence: 99%

Antiphospholipid antibodies in end‐stage renal disease: A systematic review and meta‐analysis

Merashli

Bucci

Pastori

et al. 2020

Hemodialysis International

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“…Anti-cardiolipin antibodies have been associated with thrombotic risk, and its presence must be discarded in SLE patients. Also, a detailed assessment of cardiovascular history is of utmost importance due to the intrinsic cardiovascular risk of SLE [77]. Since LN patients are exposed to immunosuppressive treatment throughout their lives, the added exposure after a kidney transplant could increase the risk of neoplasms.…”

Section: Kidney Transplantation and Lnmentioning

confidence: 99%

Update on Lupus Nephritis: Looking for a New Vision

Morales

Galindo

Trujillo

et al. 2020

Nephron

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Lupus nephritis (LN) is one of the most common manifestations of systemic lupus erythematosus (SLE), affecting approximately 40% of patients with lupus. It represents a major risk factor for morbidity and mortality, and 10% of patients with LN will develop end-stage kidney disease (ESKD). Therefore, there are a number of areas for improvement in the field of LN such as the search for new clinical biomarkers with a more accurate correlation with lupus activity and the redefinition of the histological classification into different subgroups in order to guide a personalized treatment. Although the role of protocol repeat kidney biopsies in LN is controversial, recent publications suggest that repeat histological assessment can be useful in guiding therapeutic decisions that may yield toward precision medicine. In the last decade, LN therapy has remained largely unchanged, with a probability of achieving complete or partial remission not exceeding 60–70%. Thus, optimization of old treatment strategies and search for new agents are urgently needed in order to improve outcomes such as mortality or development of ESKD. Future trials should focus in addressing unanswered issues such as the appropriate dose and duration of immunosuppressive treatment, timing of steroid withdrawal, and drug toxicity. In addition, data are still lacking regarding pregnancy and kidney transplantation in LN and knowledge about these important areas is essential for the management of a subset of patients with SLE. In summary, several major gaps are still present in the therapeutic approach and follow-up of patients with LN. The development of new clinical trial designs will be crucial in the search to improve long-term outcomes.

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“…Whether the "cool-down" effect also appears on aPL and leads to the lower prevalence of positive aPL in lupus patients with ESRD is an interesting topic for future research. Other studies have revealed that patients with positive aPL have a higher risk of thromboembolic events, which can further affect the circulation of kidney grafts [13][14][15]. In our study, only 1 patient had APS and progressed to GF.…”

Section: Discussionmentioning

confidence: 44%

The Outcome of Kidney Transplantation in Lupus Patients

Lin

Tsai

Lee

et al. 2022

Preprint

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Kidney transplantation is one of the treatments for end-stage renal disease in lupus patients. The impact of lupus activity on graft survival is a concern. In this study, we aimed to analyze graft survival and factors affecting outcome of kidney transplantation in 45 lupus patients. The graft survival rate was 98, 98, 88, 85 and 78% at 1, 5, 10, 15 and 20 years, respectively. Hypertension, positive penal reactive antibodies against HLA class 2 antigens, retransplant, younger age of lupus nephritis onset, lower postoperative C4 level and the presence of HBsAg and/or anti-HBe antibody showed significantly negative correlation on graft survival by univariate logistic regression. The only factor that is significantly associated with graft failure after adjusting above factors by multiple regression is the presence of HBsAg and/or anti-HBe antibody (p = .0161). Serological markers for activity including C3, C4 and anti-dsDNA antibody before kidney transplantation and recurrent lupus nephritis were not significantly associated with graft failure. In conclusion, in lupus patients underwent kidney transplantation, preoperative serological markers for lupus activity and recurrent lupus nephritis did not affect the graft outcome. However, hepatitis B virus serology might be a single predictor for graft failure in lupus patients.

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Antiphospholipid antibodies and renal transplant: A systematic review and meta-analysis

Cited by 12 publications

References 45 publications

Antiphospholipid antibodies in end‐stage renal disease: A systematic review and meta‐analysis

Antiphospholipid antibodies in end‐stage renal disease: A systematic review and meta‐analysis

Update on Lupus Nephritis: Looking for a New Vision

The Outcome of Kidney Transplantation in Lupus Patients

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