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posted on 12.03.2018 by Jose M. Morales, Manuel Serrano, Jose Angel Martinez-Flores, Fracisco Javier Gainza, Roberto Marcen, Manuel Arias, Fernando Escuin, Dolores Pérez, Amado Andres, Miguel Angel Martínez, Naroa Maruri, Eva Alvarez, José Luis Castañer, Marcos López-Hoyos, Antonio Serrano
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.

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