Tuesday July 03, 2018 from 09:45 to 11:15
Pre-transplant antibodies IgA-anti Beta 2 Glycoprotein I: A new predicto of early graft thrombosis after renal transplantation in the real medicine setting. An observational, multicenter and prospective study
Manuel Serrano Blanco1, Jose Angel KJA Martinez Flores 21, Dolores Perez1, Jose Maria Morales1,8, Javier Gainza2, Roberto Marcen9, Fernando Escuin3, Miguel Angel Martinez7, Eva Alvarez2, Naroa Maruri2, Jose Luis Castañer6, Marcos Lopez-Hoyos4, Antonio Serrano1.
1Servicio de Inmunologia, Hospital 12 de Octubre, Madrid, Spain; 2Servicio de Nefrología, Hospital Cruces, Baracaldo, Spain; 3Servicio de Nefrologia, Hospital La Paz, Madrid, Spain; 4Servicio de Nefrologia, Hospital de Valdecilla, Santander, Spain; 5Servicio de Inmunologia, Hospital de Valdecilla, Santander, Spain; 6Servicio de Inmunologia, Hospital Ramon y Cajal, Madrid, Spain; 7Servicio Anatomia patologica, Hospital 12 de Octubre, Madrid, Spain; 8Servicio de Nefrologia, Hospital 12 de Octubre, Madrid, Spain; 9Servicio de Inmunologia, Hospital Ramon y Cajal, Madrid, Spain
Background: Graft thrombosis is a devastating complication after renal transplantation. In a monocenter study, we recently described the association of antibodies anti Beta-2-Glycoprotein-I (IgA-ab2GP1) with early graft loss mainly by thrombosis.
Methods: We performed a multicenter study including 740 patients of five hospitals of the Spanish Forum Renal Group transplanted from 2000-2002 and prospectively followed for ten years. The presence of IgA-aB2GP1 in pretransplant serum was retrospectively examined.
Results: At transplantation 288 patients were positive for IgA-B2GP1 (29%, Group-1 and the remaining were negative (Group-2). Graft loss at 6 months was higher in Group-1 (12.5% vs 4.2% p˂0.001) and vessel thrombosis was the most frequent cause of early graft loss, especially in Group-1 (6.9% vs 0.4% p ˂0.001). Of note, IgA-aB2GP1 was the most important independent risk factor for graft thrombosis (OR: 5.05; 95% CI: 3.05 to 8.35, p ˂0.001). In addition, the presence of IgA-aB2GP1 was associated with early graft loss and delayed graft function. Survival figures were also lower in Group-1. At ten years, non-censored graft survival was lower in Group-1 compared with Group-2 (60.4% vs 76.8% p<0.001) and mortality was significantly higher in Group 1 (19.8 % vs 12.2%, p=0.005).
Conclusions: In a prospective multicenter study, we have been able to corroborate that pre-transplant presence of IgA-aB2GP1 was the main risk factor for graft thrombosis and early graft loss. Therefore, a prospective study to evaluate the efficacy and safety of prophylactic anticoagulation to avoid this severe complication is mandatory.
Astellas Pharma Inc. . Fondo de Investigaciones Sanitarias, cofunded by EU FEDER funds (PI14-00360)..