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Antiphospholipid antibody syndrome (APAS) is characterized by the presence of anticardiolipin antibodies (ACA) in association with thrombotic disorders of arterial and/or venus systems, spontaneous abortion(s) or thrombocytopenia. In this multicenter study, 502 ESRD patients were screened to determine frequency of APAS, potential risk associated with APAS and strategies for therapeutic intervention. Ninety-three of these patients (19%) had high titer of ACA. Twenty-five of these patients had documented evidence of one or more of the thrombotic disorders such as lupus, frequent abortions, frequent thrombosis of A-V shunts, biopsy-proven microrenal angiopathy, or thrombocytopenia. Of these 25 patients, 13 received either cadaveric or living donor transplants either with (4 patients) or without (9 patients), concomitant anti-coagulation therapy. All of these 9 patients with APAS without the benefit of anti-coagulation therapy lost their allografts within one week due to renal thrombosis. In contrast 3 out of 4 patients with APAS transplanted with concomitant anti-coagulation therapy maintained their allografts for over 2 years. The fourth patient lost his graft within a week due to thrombosis. Of the remaining 68 patients with high titers ACA but no evidence of thrombotic disorders, 37 received either cadaveric or living donor kidney transplantation. Their one-year graft survival is 100%.
Our data suggest that while 19% of our ESRD patients exhibit high titer of ACA, only 5% of the patients have APAS. The patients with APAS are at high risk of post-transplant renal thrombosis. However, anti-coagulation therapy could rescue these APAS patients from post-transplant thrombosis.