APL and Transplantation

Thromboembolic complications after transplant have been associated with inherited thrombophilic disorders, including deficiencies of antithrombin, protein C, protein S, factor V Leiden, the prothrombin G20210A and MTHFR C585C gene mutations, and dysfibrinogenemias.

Acquired disorders associated with transplant-related thrombosis include aPLs, malignancy, myeloproliferative disorders, heparin-induced thrombocytopenia, and hyper-homocysteinemia.

In the majority of the solid-organ and tissue transplants, the presence of aPL should be considered as a significant risk factor for any potential transplant candidate. So should it be in cases of prosthetic replacement surgeries.

The greatest risk is found in the first 6 months after transplantation. For some patients, however, the hypercoagulable state persists throughout life, and thrombotic loss of the transplanted organ can occur years after transplantation surgery. Peritoneal dialysis in patients awaiting renal transplantation appears to be at utmost risk.

Treatment for aPL-associated risks remains focused on intense anticoagulation therapy. Some patients, even on anticoagulant drugs, suffer aPL-related transplant failure. The use of immunosuppressive agents has not proven to have a marked effect on aPL titers, and has little effect on clinical events.

Given the serious psychological and economic impact of irreversible thrombosis in a transplanted organ, the modest expense of pretransplant aPL screening should be readily justified. So should be in prosthetic replacement surgeries.

References

McIntyre JA, Wagenknecht DR (2003) Antiphospholipid antibodies and renal transplantation: a risk assessment. Lupus 12(7):555-559 Wagenknecht DR, Becker DG, LeFor WM, McIntyre JA (1999) Antiphospholipid antibodies are a risk factor for early renal allograft failure. Transplantation 68(2):241-246 Wagenknecht DR, Fastenau DR, Torry RJ, Becker DG, LeFor WM, Carter CB et al (2000) Risk of early renal allograft failure is increased for patients with antiphospholipid antibodies. Transpl Int 13(Suppl 1):S78-S81

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