Anticardiolipin antibodies and hepatic artery thrombosis after liver transplantation.
BACKGROUND
Hepatic artery thrombosis (HAT) remains a devastating complication after liver transplantation. Various factors have been implicated in the pathogenesis of HAT, such as clotting abnormalities, increased hematocrit, and technical complications, but the role of anticardiolipin antibodies has not been evaluated. We investigated the possible association between HAT and anticardiolipin antibodies in adult patients who underwent liver transplantation.


METHODS
Seven patients with HAT after orthotopic liver transplantation, 28 liver recipients without HAT, and 35 normal blood donors were evaluated. Determination of IgM and IgG anticardiolipin antibodies was performed by enzyme-linked immunosorbent assay using pretransplant serum from all allograft recipients. Clinical information was obtained from chart review. Fisher's exact test and Wilcoxon rank sum test were used for statistical analysis, and all P-values were two-tailed.


RESULTS
Overall, 22 of 35 (63%) liver recipients had a positive anticardiolipin antibody test (either IgG or IgM titer >4 SD from the normal controls). The test was positive in 7 liver recipients (100%) with HAT compared with 15 out of 28 patients (54%) without HAT (P=0.031). As compared with liver recipients without HAT, patients with HAT also tended to have a higher mean anticardiolipin titer of IgG and IgM and a lower pretransplant platelet count; however, these differences were not significant.


CONCLUSIONS
Our findings indicate that anticardiolipin antibodies are frequently elevated in patients with liver failure and may contribute to the pathogenesis of HAT after liver transplantation. Other potential consequences of anticardiolipin antibodies in end-stage liver disease remain to be determined.
Pascual
M
M
Transplantation Unit, Massachusetts General Hospital, Boston 02114, USA.
Thadhani
R
R
Laposata
M
M
Williams
W W
WW
Farrell
M L
ML
Johnson
S M
SM
Tolkoff-Rubin
N
N
Cosimi
A B
AB
D000328:Adult; D002308:Cardiolipins / Q000276:immunology*; D005260:Female; D006499:Hepatic Artery; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood*; D007075:Immunoglobulin M / Q000097:blood*; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D013927:Thrombosis / Q000097:blood* / Q000209:etiology*
D002308:Cardiolipins; D007074:Immunoglobulin G; D007075:Immunoglobulin M