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Pretransplant IgA-Anti-Beta 2 Glycoprotein I Antibodies As a Predictor of Early Graft Thrombosis after Renal Transplantation in the Clinical Practice: A Multicenter and Prospective Study

BACKGROUND: Graft thrombosis is a devastating complication after renal transplantation. We recently described the association of anti-beta-2-glycoprotein-I (IgA-ab2GP1) antibodies with early graft loss mainly caused by thrombosis in a monocenter study. METHODS: Multicenter prospective observational...

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Detalles Bibliográficos
Autores principales: Morales, Jose M., Serrano, Manuel, Martinez-Flores, Jose Angel, Gainza, Fracisco Javier, Marcen, Roberto, Arias, Manuel, Escuin, Fernando, Pérez, Dolores, Andres, Amado, Martínez, Miguel Angel, Maruri, Naroa, Alvarez, Eva, Castañer, José Luis, López-Hoyos, Marcos, Serrano, Antonio
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5857545/
https://www.ncbi.nlm.nih.gov/pubmed/29593726
http://dx.doi.org/10.3389/fimmu.2018.00468
Descripción
Sumario:BACKGROUND: Graft thrombosis is a devastating complication after renal transplantation. We recently described the association of anti-beta-2-glycoprotein-I (IgA-ab2GP1) antibodies with early graft loss mainly caused by thrombosis in a monocenter study. METHODS: Multicenter prospective observational cohort study. SETTING AND PARTICIPANTS: Seven hundred forty patients from five hospitals of the Spanish Forum Renal Group transplanted from 2000 to 2002 were prospectively followed-up for 10 years. OUTCOMES: Early graft loss and graft loss by thrombosis. MEASUREMENTS: The presence of IgA anti-B2GP1 antibodies in pretransplant serum was examined using the same methodology in all the patients. RESULTS: At transplantation, 288 patients were positive for IgA-B2GP1 (39%, Group-1) and the remaining were negative (Group-2). Graft loss at 6 months was higher in Group-1 (12.5 vs. 4.2% p < 0.001), vessel thrombosis being the most frequent cause of early graft loss, especially in Group-1 (6.9 vs. 0.4% p < 0.001). IgA-aB2GP1 was the most important independent risk factor for graft thrombosis (hazard ratio: 13.83; 95% CI: 3.17–60.27, p < 0.001). Furthermore, the, presence of IgA-aB2GP1 was associated with early graft loss and delayed graft function. At 10 years, survival figures were also lower in Group-1: graft survival was lower compared with Group-2 (60.4 vs. 76.8%, p < 0.001). Mortality was significantly higher in Group-1 (19.8 vs. 12.2%, p = 0.005). LIMITATIONS: Patients were obtained during a 3-year period (1 January 2000–31 December 2002) and kidneys were only transplanted from brain-dead donors. Nowadays, the patients are older and the percentage of sensitized and retransplants is high. CONCLUSION: In a prospective observational multicenter study, we were able to corroborate that pretransplant presence of IgA-aB2GP1 was the main risk factor for graft thrombosis and early graft loss. Therefore, a prospective study is needed to evaluate the efficacy and safety of prophylactic anticoagulation to avoid this severe complication.