AUTHOR=Morales Jose M. , Serrano Manuel , Martinez-Flores Jose Angel , Gainza Fracisco Javier , Marcen Roberto , Arias Manuel , Escuin Fernando , Pérez Dolores , Andres Amado , Martínez Miguel Angel , Maruri Naroa , Alvarez Eva , Castañer José Luis , López-Hoyos Marcos , Serrano Antonio 

TITLE=Pretransplant IgA-Anti-Beta 2 Glycoprotein I Antibodies As a Predictor of Early Graft Thrombosis after Renal Transplantation in the Clinical Practice: A Multicenter and Prospective Study

JOURNAL=Frontiers in Immunology

VOLUME=9

YEAR=2018

URL=https://www.frontiersin.org/journals/immunology/articles/10.3389/fimmu.2018.00468

DOI=10.3389/fimmu.2018.00468

ISSN=1664-3224

ABSTRACT=<sec id="ST1"><title>Background</title><p>Graft thrombosis is a devastating complication after renal transplantation. We recently described the association of anti-beta-2-glycoprotein-I (IgA-ab2GP1) antibodies with early graft loss mainly caused by thrombosis in a monocenter study.</p></sec><sec id="ST2"><title>Methods</title><p>Multicenter prospective observational cohort study.</p></sec><sec id="ST3"><title>Setting and participants</title><p>Seven hundred forty patients from five hospitals of the Spanish Forum Renal Group transplanted from 2000 to 2002 were prospectively followed-up for 10 years.</p></sec><sec id="ST4"><title>Outcomes</title><p>Early graft loss and graft loss by thrombosis.</p></sec><sec id="ST5"><title>Measurements</title><p>The presence of IgA anti-B2GP1 antibodies in pretransplant serum was examined using the same methodology in all the patients.</p></sec><sec id="ST6"><title>Results</title><p>At transplantation, 288 patients were positive for IgA-B2GP1 (39%, Group-1) and the remaining were negative (Group-2). Graft loss at 6 months was higher in Group-1 (12.5 vs. 4.2% <italic>p</italic> &lt; 0.001), vessel thrombosis being the most frequent cause of early graft loss, especially in Group-1 (6.9 vs. 0.4% <italic>p</italic> &lt; 0.001). IgA-aB2GP1 was the most important independent risk factor for graft thrombosis (hazard ratio: 13.83; 95% CI: 3.17–60.27, <italic>p</italic> &lt; 0.001). Furthermore, the, presence of IgA-aB2GP1 was associated with early graft loss and delayed graft function. At 10 years, survival figures were also lower in Group-1: graft survival was lower compared with Group-2 (60.4 vs. 76.8%, <italic>p</italic> &lt; 0.001). Mortality was significantly higher in Group-1 (19.8 vs. 12.2%, <italic>p</italic> = 0.005).</p></sec><sec id="ST7"><title>Limitations</title><p>Patients were obtained during a 3-year period (1 January 2000–31 December 2002) and kidneys were only transplanted from brain-dead donors. Nowadays, the patients are older and the percentage of sensitized and retransplants is high.</p></sec><sec id="ST8"><title>Conclusion</title><p>In a prospective observational multicenter study, we were able to corroborate that pretransplant presence of IgA-aB2GP1 was the main risk factor for graft thrombosis and early graft loss. Therefore, a prospective study is needed to evaluate the efficacy and safety of prophylactic anticoagulation to avoid this severe complication.</p></sec>