[Antiphospholipid antibody syndrome: a priori a contraindication to kidney transplantation?].
BACKGROUND
The antiphospholipid antibody syndrome (APLS) is characterised by the presence of antiphospholipid antibodies in association with thrombotic disorders of the arterial and/or venous system, spontaneous abortion and thrombocytopenia. Several studies have shown that end-stage renal disease patients with APLS are at extremely high risk for graft thrombosis and graft loss after kidney transplantation.


METHODS
We report on the treatment and clinical courses of 6 APLS renal transplant patients.


RESULTS
Of 3 patients treated with low-dose subcutaneous heparin two had early graft loss due to venous graft thrombosis; of those patients treated by systemic heparin (PTT goal 45-55 s) and followed by coumadin (INR 2.5-3.0) only one had early graft loss whereas 2 grafts are doing well 2 years post-transplant.


CONCLUSIONS
Our experience as well as recently published data suggest that kidney transplantation can be performed successfully in APLS patients if anticoagulation therapy is performed consistently. A general APL antibody screening prior to kidney transplantation does not seem to be justified at present. A prospective, randomised multicenter study is warranted to evaluate the management of these patients with respect to intensity, type and duration of anticoagulation therapy.
Rubenwolf
P
P
Urologische Klinik und Poliklinik sowie Medizinische Klinik, Abteilung Nephrologie mit Transplantationszentrum der Bayerischen Julius-Maximilians-Universität Würzburg. rubenwolf_p@klinik.wuerzburg.de
Lopau
K
K
Gerharz
E W
EW
Heidbreder
E
E
Riedmiller
H
H
D000328:Adult; D000925:Anticoagulants / Q000008:administration & dosage / Q000627:therapeutic use*; D016736:Antiphospholipid Syndrome / Q000097:blood / Q000150:complications / Q000175:diagnosis; D006085:Graft Survival; D006493:Heparin / Q000008:administration & dosage / Q000627:therapeutic use; D006801:Humans; D007275:Injections, Intravenous; D007279:Injections, Subcutaneous; D007430:Intraoperative Care; D016030:Kidney Transplantation / Q000009:adverse effects / Q000473:pathology; D008180:Lupus Erythematosus, Systemic / Q000097:blood / Q000150:complications / Q000175:diagnosis; D010314:Partial Thromboplastin Time; D011183:Postoperative Complications / Q000517:prevention & control*; D012307:Risk Factors; D013927:Thrombosis / Q000517:prevention & control*; D014859:Warfarin / Q000008:administration & dosage / Q000627:therapeutic use
D000925:Anticoagulants; D014859:Warfarin; D006493:Heparin