title: Plasmapheresis in a patient with antiphospholipid syndrome before living-donor kidney transplantation: a case report.
abstract: BACKGROUND
  Early graft thrombosis and bleeding complications remain important causes of early graft loss following kidney transplantation in patients with antiphospholipid syndrome. Anti-β2-glycoprotein I IgG is a disease-specific antibody in patients with antiphospholipid syndrome. Although plasmapheresis is partially effective for antibody removal, the optimal treatment allowing successful transplantation in patients with antiphospholipid syndrome has not been established. This is the first report of a patient with antiphospholipid syndrome who successfully underwent living-donor kidney transplantation following prophylactic plasmapheresis for removal of anti-β2-glycoprotein I IgG.
  
  
  METHODS
  A 37-year-old Japanese female was scheduled to undergo a living-donor kidney transplant from her mother. At age 25 years, she experienced renal vein thrombosis, was diagnosed with antiphospholipid syndrome secondary to systemic lupus erythematosus, and was subsequently treated with prednisolone and warfarin. At age 37 years, she was diagnosed with end stage kidney disease, requiring maintenance hemodialysis because of recurrent renal vein thrombosis despite taking anticoagulation therapy. The pretreatment protocol consisted of prophylactic plasmapheresis plus full anticoagulation therapy to counteract the risks of early graft thrombosis. Anticardiolipin and anti-β2-glycoprotein I IgGs were successfully removed by both double filtration plasmapheresis and plasma exchange. The allograft kidney began to function soon after transplantation. No obvious thrombotic complications were observed after transplantation, although anti-β2-glycoprotein I IgG increased to the level observed before plasmapheresis. One year after transplantation, the patient's kidney function remains stable while receiving anticoagulation therapy as well as a maintenance immunosuppressive regimen.
  
  
  CONCLUSIONS
  Prophylactic plasmapheresis plus full anticoagulation therapy may be an effective strategy in patients with antiphospholipid syndrome undergoing living-donor kidney transplantation.
authors.affiliation: Division of Nephrology and Dialysis, Department of CardioRenal and Cerebrovascular Medicine, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa 761-0793, Japan. sofue@med.kagawa-u.ac.jp.
authors.forename: Tadashi
authors.initials: T
authors.lastname: Sofue
authors.forename: Yushi
authors.initials: Y
authors.lastname: Hayashida
authors.forename: Taiga
authors.initials: T
authors.lastname: Hara
authors.forename: Kazuyo
authors.initials: K
authors.lastname: Kawakami
authors.forename: Nobufumi
authors.initials: N
authors.lastname: Ueda
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Kushida
authors.forename: Masashi
authors.initials: M
authors.lastname: Inui
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Dobashi
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Kakehi
authors.forename: Masakazu
authors.initials: M
authors.lastname: Kohno
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D000925:Anticoagulants / Q000627:therapeutic use; D016736:Antiphospholipid Syndrome / Q000209:etiology / Q000628:therapy*; D001324:Autoantigens / Q000276:immunology; D005260:Female; D006084:Graft Rejection / Q000517:prevention & control; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood / Q000276:immunology; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007676:Kidney Failure, Chronic / Q000209:etiology* / Q000601:surgery; D016030:Kidney Transplantation; D019520:Living Donors; D008180:Lupus Erythematosus, Systemic / Q000150:complications* / Q000188:drug therapy; D010951:Plasma Exchange; D010956:Plasmapheresis; D011300:Preoperative Care / Q000379:methods*; D006435:Renal Dialysis; D019851:Thrombophilia / Q000188:drug therapy / Q000209:etiology / Q000628:therapy*; D013927:Thrombosis / Q000517:prevention & control*; D014859:Warfarin / Q000627:therapeutic use; D053482:beta 2-Glycoprotein I / Q000276:immunology
chemical_list: D000305:Adrenal Cortex Hormones; D000925:Anticoagulants; D001324:Autoantigens; D007074:Immunoglobulin G; D007166:Immunosuppressive Agents; D053482:beta 2-Glycoprotein I; D014859:Warfarin