DETRIMENTAL EFFECT OF ANTI-PHOSPHOLIPID ANTIBODIES IN KIDNEY TRANSPLANTATION; A CASE STUDY.

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DETRIMENTAL EFFECT OF ANTI-PHOSPHOLIPID ANTIBODIES IN KIDNEY TRANSPLANTATION; A CASE STUDY.
Michele Prod BS , Shonna Cotton BS , Sylvia Piggott BS , Maria Oppermann BS , Christine Braun MS , Heather Lauwers BSN and Anat R. Tambur, DMD, PhD . Chicago IL, Rush Medical Center, 60612, Transplantation .

A 30 yo, Indian male with ESRD due to IgA nephropathy was evaluated for pre-kidney transplantion. HLA typing; PRA analysis by cytotoxic ( 0%) and solid phase (flow beads - no class I nor class II HLA antibodies) assays were performed. Autologous XM was negative.
An altruistic donor – 22 yo, female, Medical student – became available. Final XM was performed – cytotoxic – T & B negative; Flow cytometry – T & B negative.
Several days after transplantation the patient presented with symptoms of acute humoral rejection. Post transplant flow cytometry XM and Flow-PRA analyses were performed. Both, T & B XM were negative, and no HLA (class I or class II) antibodies were detected. A positive B cell (negative T cell) cytotoxic XM, not reducible by heat inactivation, was noted.
At this point we suspected the presence of antiphospholipid (aPL) antibodies and serum specimens were sent to Dr McIntyre’s laboratory. Analysis of pre transplant serum showed increased levels of a particular subtype of aPL – aPE, IgG antibodies (5 MoM; normal range <4 MoM). Post transplant specimen had aPE – IgG antibodies at a 6-7 MoM. Based on this finding the transplant surgeons decided to treat the patient with heparin to minimize coagulation damage.
IgA nephropathy is an (auto) immune-complex-mediated glomerulonephritis. Antiphospholipid antibodies (aPL) are autoantibodies that bind to phospholipid-binding proteins. It has been shown that the prevalence of aPL is significantly higher in ESRD patients than in blood donors, and that they are associated with significant morbidity and mortality in SLE- renal transplant recipients.
The case presented here suggests that a proactive analysis of aPL in patients with autoimmune diseases should be performed.