Risk of early renal allograft failure is increased for patients with antiphospholipid antibodies

Abstract

Renal allograft thrombosis can cause transplant failure. Because antiphospholipid antibodies (aPA) are associated with thrombosis, we investigated pretransplant sera from patients with early renal allograft failure to determine if aPA were present. Fifty-six final crossmatch (FxM) sera from patients whose transplant failed within 16 days were compared to FxM sera from the next sequential transplant patients. The sera were tested for IgG, IgM, and IgA antibodies to cardiolipin, phosphatidylserine, and phosphatidylethanolamine. aPA were identified in 57 YO of FxM sera from patients with early non-function versus 35 % of FxM sera from patients with functioning grafts (P = 0.02). Historical sera from 11 aPA-positive patients contained aPA up to 18 months prior to transplantation. Since aPA were present in historical sera, testing for aPA can identify certain patients at risk for early allograft failure. The involvement of aPA in early allograft loss is supported by studies demonstrating aPA recovery from an explanted failed transplant.

Early endosome as a pathogenic target for antiphosphatidylethanolamine antibodies

“…(ii) NOX-derived ROS mediates the inflammatory response by regulating cytokine signaling (32)(33)(34)(35)(36)(37), and our data indicate that the TNF-α-dependent production of ROS was augmented by the endosomal accumulation of IgM-Dur; thus, endosomal PE binding may exacerbate a preexisting inflammatory condition. These findings are consistent with aPE being a risk factor in cardiovascular diseases and in organ transplant, where aPE-positive recipients, in particular, are at risk for transplant failure (3,8,11,12).…”

“…antiphospholipid syndromes | antiphosphatidylethanolamine | early endosome | duramycin | phosphatidylethanolamine A ntiphosphatidylethanolamine (aPE) is a poorly understood form of autoimmune condition with important clinical implications. A growing number of studies indicate that antibodies against phosphatidylethanolamine (PE) are positively correlated with the main clinical manifestations of antiphospholipid syndrome (APS), including thrombosis and repeated pregnancy loss (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12). Although different antiphospholipid autoantibodies may be present in the same patient, anti-PE antibodies are sometimes the sole antibodies in patients with symptoms of APS, which suggests that aPE functions as an independent etiological entity (2)(3)(4).…”

Antiphospholipid antibodies and renal transplantation: a risk assessment

“…In 2000, we reported the peri-and post-transplant use of low molecular weight heparin (LMWH) for 15 aPL-positive renal transplant patients. 10 The patients received 30 mg of low molecular weight heparin (LMWH) daily. Most patients became aPL-negative in the rst few post-transplant weeks and all but one were aPL-negative within three months of transplant.…”

Nephrotic syndrome in adults: symptoms and management

“…[856][857][858] One important consideration is that patients who have antiphospholipid antibodies may experience dialysis vascular access clotting or allograft thrombosis and may require prophylactic anticoagulation. [859][860][861][862]…”