Clinical significance of antiphospholipid antibodies on allograft and patient outcome after kidney transplantation.

Introduction: Antiphospholipid antibodies (APA) have acquired great relevance as atherogenic factors. Kidney graft recipients have a higher prevalence of cardiovascular disease (CVD) than the general population, which is not fully explained by the classical vascular risk factors. The aim of this study was to assess the influence of APA on kidney graft and patient outcomes with special focus on CVD.

Materials And Methods: One hundred ninety seven cadaveric kidney graft recipients with functioning grafts for more than 1 year underwent determination of serum APA titres (anti-cardiolipin and anti-beta-2 glycoprotein I IgG and IgM antibodies) in one pretransplant serum and in second one obtained at least 1 year after transplantation. In the case of postransplant CVD, the postransplant serum was always chosen before the cardiovascular event. The enzyme linked immunosorbent assay (ELISA) for anti-cardiolipin antibodies was performed in the presence of cofactor.

Results: Twenty-seven percent of patients had pretransplant APA, whereas 15.7% developed postransplant APA de novo. The presence of pretransplant serum APA was not associated with a higher risk of postransplant CVD. The development of postransplant APA de novo showed a relationship to an acute rejection episode (ARE): the frequency of patients who had APA de novo was higher among patients who suffered ARE (18.8% vs 7%, P = .01). In addition, in patients who suffered any ARE, the production of postransplant APA was associated with a higher frequency of postransplant CVD.

Conclusions: The detection of APA is not an independent risk factor for CVD after kidney transplantation. The inflammatory phenomena secondary to an ARE may be responsible for the de novo production of postransplant APA, which may be associated with the development of postransplant CVD. The control of cardiovascular risk factors should be intensified in this special group of patients.