CASE REPORT article
Front. Nephrol.
Sec. Kidney Transplantation
Volume 5 - 2025 | doi: 10.3389/fneph.2025.1572641
This article is part of the Research TopicCase reports in kidney transplantationView all articles
Failure of Eculizumab to block complement to prevent relapse of anti-phospholipid syndrome in kidney transplant recipient
Provisionally accepted
Thibault LabanFredéric PigneurConstance Guillaud
Marie-Agnes DRAGON-DUREYHoucine HamidiMarc MichelHamza Sakhi
Nizar JOHER
Philippe Grimbert
Antoine MOREL
Marie Matignon*- Assistance Publique Hopitaux De Paris, Paris, France
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Catastrophic antiphospholipid syndrome (CAPS) leads to organ dysfunction due to thrombotic microangiopathy (TMA). Complement may play a role in CAPS and its blockade could prevent antiphospholipid syndrome (APS) complications after kidney transplantation (KT).We report here a recurrence of APS after KT in a 38-year-old woman with early acute cortical kidney allograft necrosis despite preventive eculizumab treatment probably due to insufficient complement blockade.The patient had a recurrent but controlled CAPS for years with renal dysfunction leading to a preemptive KT. Anticoagulation and eculizumab were used to prevent thrombosis and TMA after KT. She developed acute kidney injury (AKI) with incomplete biological TMA. Imaging showed renal allograft cortical necrosis. In the absence of donor-specific anti-HLA antibodies, we concluded a relapse of APS. Additional doses of eculizumab and plasma exchange allowed normalisation of biological tests and improvement of kidney allograft function. Retrospective complement analysis showed incomplete blockade at the time of AKI. One year after KT, renal allograft function remained impaired.
Keywords: kidney tranplantation, Anti phospholipid syndrome, Eculizumab, thrombotic micro angiopathy, Cortical necrosis
Received: 07 Feb 2025; Accepted: 21 Apr 2025.
Copyright: © 2025 Laban, Pigneur, Guillaud, DRAGON-DUREY, Hamidi, Michel, Sakhi, JOHER, Grimbert, MOREL and Matignon. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Marie Matignon, Assistance Publique Hopitaux De Paris, Paris, France
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