title: The Presence of Pretransplant Antiphospholipid Antibodies IgA Anti-β-2-Glycoprotein I as a Predictor of Graft Thrombosis After Renal Transplantation.
abstract: Vessel thrombosis is a severe complication after renal transplantation. Antibodies anti-β-2 glycoprotein-I of IgA isotype (IgA-aB2GP1) have been linked to thrombotic events and mortality in hemodialysis patients.
  
  
  
  All kidney transplanted patients from 2000 to 2011 (n = 1375) in our hospital were followed up for 2 years, evaluating 3 time periods.
  
  
  
  At transplantation, 401 patients were positive for IgA-aB2GPI (29.2%, group 1), and the remaining patients were negative (group 2). Graft loss at 6 months posttransplantation was higher in group 1 (18% vs 7.2%; P < 0.001). The most frequent cause of early graft loss was vessel thrombosis, especially in group 1 (12.2% vs 2.6% of patients; P < 0.001). In fact, vessel thrombosis was the most important cause of graft loss in the 3 time periods, irrespective of demographic changes and introduction of transplantation with asystolic donors.Notably, IgA-aB2GP1 was an independent risk factor for graft thrombosis (odds ratio, 5.047; P < 0.001). Furthermore, the presence of IgA-aB2GP1 was associated with early graft loss and delayed graft function. Mortality at 24 months was also higher in group 1.
  
  
  
  In conclusion, pretransplant IgA-aB2GP1 was the main risk factor for graft thrombosis and early graft loss. Further research should be made on whether anticoagulation in antibody-positive patients could ameliorate this catastrophic complication.
authors.affiliation: 1 Department of Immunology, Instituto de Investigación Hospital Universitario, Madrid, Spain. 2 Department of Nephrology, Instituto de Investigación Hospital Universitario, Madrid, Spain. 3 Department of Urology, Instituto de Investigación Hospital Universitario, Madrid, Spain. 4 Department of Pathology, Instituto de Investigación Hospital Universitario, Madrid, Spain. 5 Immunology Section, Universidad San Pablo-CEU, Madrid, Spain. 6 Facultad de Medicina, Universidad Complutense, Madrid, Spain.
authors.forename: Jose Maria
authors.initials: JM
authors.lastname: Morales
authors.forename: Manuel
authors.initials: M
authors.lastname: Serrano
authors.forename: Jose Angel
authors.initials: JA
authors.lastname: Martínez-Flores
authors.forename: Dolores
authors.initials: D
authors.lastname: Pérez
authors.forename: Maria José
authors.initials: MJ
authors.lastname: Castro
authors.forename: Elena
authors.initials: E
authors.lastname: Sánchez
authors.forename: Florencio
authors.initials: F
authors.lastname: García
authors.forename: Alfredo
authors.initials: A
authors.lastname: Rodríguez-Antolín
authors.forename: Marina
authors.initials: M
authors.lastname: Alonso
authors.forename: Eduardo
authors.initials: E
authors.lastname: Gutierrez
authors.forename: Enrique
authors.initials: E
authors.lastname: Morales
authors.forename: Manuel
authors.initials: M
authors.lastname: Praga
authors.forename: Esther
authors.initials: E
authors.lastname: González
authors.forename: Amado
authors.initials: A
authors.lastname: Andrés
authors.forename: Estela
authors.initials: E
authors.lastname: Paz-Artal
authors.forename: Miguel Angel
authors.initials: MA
authors.lastname: Martínez
authors.forename: Antonio
authors.initials: A
authors.lastname: Serrano
mesh_terms: D017152:Antibodies, Antiphospholipid / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D016009:Chi-Square Distribution; D016208:Databases, Factual; D005260:Female; D006085:Graft Survival; D006801:Humans; D007070:Immunoglobulin A / Q000097:blood*; D053208:Kaplan-Meier Estimate; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012307:Risk Factors; D013030:Spain; D013927:Thrombosis / Q000097:blood / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality; D013997:Time Factors; D016896:Treatment Outcome; D053482:beta 2-Glycoprotein I / Q000276:immunology*
chemical_list: D017152:Antibodies, Antiphospholipid; D015415:Biomarkers; D007070:Immunoglobulin A; D053482:beta 2-Glycoprotein I