Frequency, potential risk and therapeutic intervention in end-stage renal disease patients with antiphospholipid antibody syndrome - A multicenter study

Background. Antiphospholipid antibody syndrome (APAS) is characterized by t he presence of anticardiolipin antibodies (ACA) in association with thrombo tic disorders of arterial and/or venus systems, spontaneous abortion(s) or thrombocytopenia. Methods. In this multicenter study, 502 end-stage renal disease (ESRD) pati ents awaiting renal transplants were screened to determine the frequency of APAS, the potential risk associated with APAS, and strategies for therapeu tic intervention. Ninety-three patients (19%) had high titers of ACA. Twent y-three patients had documented evidence of one or more of the thrombotic d isorders such as lupus, frequent abortions, frequent thrombosis of arteriov enous shunts, biopsy-proven microrenal angiopathy, or thrombocytopenia and thus were diagnosed with APAS. Of these 23 patients, 11 received kidney tra nsplants either with (4 patients) or without (7 patients), concomitant anti coagulation therapy. Results. All seven of the patients with APAS not treated with anticoagulati on therapy lost their allografts within 1 week as a result of renal thrombo sis. In contrast, three out of four transplant patients with APAS treated w ith anticoagulation therapy maintained their allografts for over 2 years. T he fourth patient lost his graft within a week because of thrombosis. Of th e remaining 70 patients with high titers of ACA but no evidence of thrombot ic disorders, 37 received kidney transplants. None lost their allografts as a result of thrombosis. Our data suggest that, although 19% of our ESRD pa tients exhibit high titer of ACA, only 5% of the patients have APAS. Conclusion. In conclusion, our data suggest that the patients with APAS are at high risk of posttransplant renal thrombosis. Anticoagulation therapy c ould prevent patients from posttransplant thrombosis in patients with APAS.