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

Front Immunol. 2018 Mar 12:9:468. doi: 10.3389/fimmu.2018.00468. eCollection 2018.

Abstract

Background: 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.

Methods: Multicenter prospective observational cohort study.

Setting and participants: 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.

Outcomes: Early graft loss and graft loss by thrombosis.

Measurements: The presence of IgA anti-B2GP1 antibodies in pretransplant serum was examined using the same methodology in all the patients.

Results: 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% p < 0.001), vessel thrombosis being the most frequent cause of early graft loss, especially in Group-1 (6.9 vs. 0.4% p < 0.001). IgA-aB2GP1 was the most important independent risk factor for graft thrombosis (hazard ratio: 13.83; 95% CI: 3.17-60.27, p < 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%, p < 0.001). Mortality was significantly higher in Group-1 (19.8 vs. 12.2%, p = 0.005).

Limitations: 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.

Conclusion: 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.

Keywords: B2GP1; IgA; antiphospholipid antibodies; antiphospholipid syndrome; autoantibodies; autoimmunity; graft thrombosis; kidney transplant.

Publication types

  • Multicenter Study
  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Cohort Studies
  • Delayed Graft Function / diagnosis*
  • Delayed Graft Function / immunology
  • Follow-Up Studies
  • Graft Survival
  • Humans
  • Immunoglobulin A / metabolism
  • Kidney / pathology*
  • Kidney Transplantation*
  • Predictive Value of Tests
  • Prognosis
  • Prospective Studies
  • Risk
  • Survival Analysis
  • Thrombosis
  • beta 2-Glycoprotein I / immunology

Substances

  • Immunoglobulin A
  • beta 2-Glycoprotein I