title: Association of early kidney allograft failure with preformed IgA antibodies to β2-glycoprotein I.
abstract: In the current immunosuppressive therapy era, vessel thrombosis is the most common cause of early graft loss after renal transplantation. The prevalence of IgA anti-β2-glycoprotein I antibodies (IgA-aB2GPI-ab) in patients on dialysis is elevated (>30%), and these antibodies correlate with mortality and cardiovascular morbidity. To evaluate the effect of IgA-aB2GPI-ab in patients with transplants, we followed all patients transplanted from 2000 to 2002 in the Hospital 12 de Octubre prospectively for 10 years. Presence of IgA-aB2GPI-ab in pretransplant serum was examined retrospectively. Of 269 patients, 89 patients were positive for IgA-aB2GPI-ab (33%; group 1), and the remaining patients were negative (67%; group 2). Graft loss at 6 months post-transplant was significantly higher in group 1 (10 of 89 versus 3 of 180 patients in group 2; P=0.002). The most frequent cause of graft loss was thrombosis of the vessels, which was observed only in group 1 (8 of 10 versus 0 of 3 patients in group 2; P=0.04). Multivariate analysis showed that the presence of IgA-aB2GPI-ab was an independent risk factor for early graft loss (P=0.04) and delayed graft function (P=0.04). There were no significant differences regarding patient survival between the two groups. Graft survival was similar in both groups after 6 months. In conclusion, patients with pretransplant IgA-aB2GPI-ab have a high risk of early graft loss caused by thrombosis and a high risk of delayed graft function. Therefore, pretransplant IgA-aB2GPI-ab may have a detrimental effect on early clinical outcomes after renal transplantation.
authors: Departments of Nephrology, jmorales@h12o.es.
authors: Jose M
authors: JM
authors: Morales
authors: Immunology, and.
authors: Jose Angel
authors: JA
authors: Martinez-Flores
authors: Departments of Nephrology.
authors: Manuel
authors: M
authors: Serrano
authors: Immunology, and.
authors: Maria José
authors: MJ
authors: Castro
authors: Immunology, and.
authors: Francisco Javier
authors: FJ
authors: Alfaro
authors: Departments of Nephrology.
authors: Florencio
authors: F
authors: García
authors: Pathology, Instituto de Investigación Hospital Universitario 12 de Octubre, Madrid, Spain;
authors: Miguel Angel
authors: MA
authors: Martínez
authors: Departments of Nephrology.
authors: Amado
authors: A
authors: Andrés
authors: Departments of Nephrology.
authors: Esther
authors: E
authors: González
authors: Departments of Nephrology.
authors: Manuel
authors: M
authors: Praga
authors: Immunology, and Immunology Section, Universidad San Pablo-CEU, Madrid, Spain; and Facultad de Medicina, Universidad Complutense, Madrid, Spain.
authors: Estela
authors: E
authors: Paz-Artal
authors: Immunology, and Immunology Section, Universidad San Pablo-CEU, Madrid, Spain; and.
authors: Antonio
authors: A
authors: Serrano
mesh_terms: D001323:Autoantibodies / Q000097:blood; D051799:Delayed Graft Function / Q000276:immunology; D005260:Female; D006085:Graft Survival / Q000276:immunology*; D006801:Humans; D007070:Immunoglobulin A / Q000276:immunology; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000276:immunology*; D011446:Prospective Studies; D051437:Renal Insufficiency / Q000276:immunology*; D012307:Risk Factors; D053482:beta 2-Glycoprotein I / Q000276:immunology*
chemical_list: D001323:Autoantibodies; D007070:Immunoglobulin A; D053482:beta 2-Glycoprotein I
keywords: immunology; kidney transplantation; survival