title: Living donor renal transplantation in patients with antiphospholipid syndrome: A case report.
abstract: BACKGROUND
  Antiphospholipid syndrome (APS), autoantibodies directed against phospholipid-binding proteins are associated with cause vascular thrombosis. Patients with APS requiring renal transplantation are at risk of early graft loss due to arterial or venous thrombosis, or thrombotic microangiopathy (TMA). Here, we report 3 cases of successful renal transplantation in patients with APS.
  
  
  RESULTS
  A 53-year-old man with end-stage renal disease (ESRD) had experienced bilateral deep venous thrombosis (DVT) in the lower extremities 16 years ago and was administered warfarin. However, he frequently experienced recurrent DVT despite of anticoagulation therapy. Before the surgery, APS was confirmed based on positive results lupus anticoagulant in serological tests. A 40-year-old man with polycystic kidney disease and a history recurrent DVT tested positive for lupus anticoagulant and anticardiolipin antibodies. Lastly, a 42-year-old woman with ESRD was diagnosed with APS 7 years ago. She also developed DVT and tested positive for lupus anticoagulant and anti-B2-glycoprotein 1.
  Warfarin was stopped 5 days before living donor renal transplantation and intravenous heparin therapy was started. During surgery, bolus heparin injections (3000 U) were administered to prevent arterial or venous thrombosis. Heparin was substituted with warfarin on postoperative day 4. The third patient (42/F) developed clinical rejection indicated by increased serum creatinine levels and donor-specific antibodies (DSA) and received steroid pulse therapy, plasmapheresis, and rituximab. This treatment restored graft function to within the normal range. The latest graft function in all patients was maintained at normal levels in the outpatient clinic.
  
  
  CONCLUSIONS
  Living donor renal transplantation may be successful in patients with APS following perioperative anticoagulation therapy. However, because of the high risk of TMA or vascular thrombosis in the early postoperative period, close monitoring for hypercoagulability and continuous anticoagulation is essential for maintaining graft function.
authors.affiliation: Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea.
authors.forename: Ji Yoon
authors.initials: JY
authors.lastname: Choi
authors.forename: Joo Hee
authors.initials: JH
authors.lastname: Jung
authors.forename: Sung
authors.initials: S
authors.lastname: Shin
authors.forename: Young Hoon
authors.initials: YH
authors.lastname: Kim
authors.forename: Duck Jong
authors.initials: DJ
authors.lastname: Han
mesh_terms: D000328:Adult; D017152:Antibodies, Antiphospholipid / Q000097:blood; D000925:Anticoagulants / Q000008:administration & dosage; D016736:Antiphospholipid Syndrome / Q000097:blood / Q000150:complications / Q000175:diagnosis / Q000628:therapy; D001323:Autoantibodies / Q000097:blood; D057915:Drug Substitution / Q000379:methods; D005260:Female; D006084:Graft Rejection / Q000175:diagnosis / Q000517:prevention & control; D006493:Heparin / Q000008:administration & dosage*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D016030:Kidney Transplantation / Q000009:adverse effects / Q000379:methods; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D010956:Plasmapheresis / Q000379:methods; D012008:Recurrence; D016896:Treatment Outcome; D020246:Venous Thrombosis / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy; D014859:Warfarin / Q000008:administration & dosage*
chemical_list: D017152:Antibodies, Antiphospholipid; D000925:Anticoagulants; D001323:Autoantibodies; D014859:Warfarin; D006493:Heparin