Clinical Epidemiology and Ageing

Anticardiolipin antibodies and 12-month graft function in kidney transplant recipients: a prognosis cohort survey.

Gauthier M, Canoui-Poitrine F, Guery E, Desvaux D, Hue S, Canaud G, Stehlé T, Lang P, Kofman T, Grimbert P, Matignon M Nephrol Dial Transplant. 2018;33(4):709-716.

<p><b>Background: </b>In kidney transplant recipients, anticardiolipin (ACL) antibodies without antiphospholipid syndrome (APS) are found in up to 38% of patients and could be associated with thrombotic events (TEs). However, the prognostic role of ACL regarding kidney transplant and patients outcomes have still not been well defined.</p><p><b>Methods: </b>We conducted an observational, monocentric, retrospective cohort study including 446 kidney transplant recipients and standardized follow-up: 36-month allograft and patient survival, 12-month estimated glomerular filtration rate (eGFR) and 3- and 12-month screening biopsies.</p><p><b>Results: </b>ACL tests were run on 247 patients, 101 were positive (ACL+ group, 41%) and 146 were negative (ACL- group, 59%). Allografts and patient survival within 36 months as TE were similar between both groups [hazard ratio (HR) = 1.18 and HR = 0.98, respectively]. The 12-month eGFR was significantly lower in the ACL+ group [median (95% confidence interval) 48.5 (35.1-60.3) versus 51.9 (39.1-65.0) mL/min/1.73 m2, P= 0.042]. ACL+ was independently associated with eGFR decrease (P = 0.04). In 12-month screening biopsies, tubular atrophy was significantly more severe in the ACL+ group compared with the ACL- group (P = 0.02).</p><p><b>Conclusions: </b>ACL without APS before kidney transplantation is an independent risk factor of eGFR decline within the first year post-transplant without over-incidence of TEs. Specific immunosuppressive therapy including mammalian target of rapamycin inhibitors should be discussed in the future.</p>

MeSH terms: Adult; Antibodies, Anticardiolipin; Female; Glomerular Filtration Rate; Graft Rejection; Graft Survival; Humans; Kidney Diseases; Kidney Transplantation; Male; Middle Aged; Prognosis; Retrospective Studies; Risk Factors; Survival Rate; Transplant Recipients
DOI: 10.1093/ndt/gfx353