Original Investigation
Antiphospholipid antibody syndrome in renal transplantation: Occurrence of clinical events in 96 consecutive patients with systemic lupus erythematosus

https://doi.org/10.1016/S0272-6386(99)70009-0Get rights and content

Abstract

We report the results of a detailed examination of clinical events associated with the antiphospholipid antibody (aPL) syndrome in 96 consecutive patients with systemic lupus erythematosus (SLE) who underwent renal transplantation between January 1, 1984, and September 1, 1996. Because of the retrospective nature of our study, we developed strict definitions of clinical events considered to be associated with the aPL syndrome. We reviewed all available hospital, clinic, and outside records of the patients with SLE who underwent transplantation at our center during this time period and noted the results of three standard serological tests for aPLs, when available. Mean follow-up of the 96 patients was 62.6 months. Eighty-five of the 96 patients (88.5%) had at least one test for aPLs performed, and 25 patients (29.4%) had at least one abnormal test result. Among these 25 patients, 15 patients (60%) had clinical events associated with aPL syndrome. Ten patients (10.4%) either died of the aPL syndrome or had an aPL-associated clinical event within 3 months of transplantation. Other morbidity from the aPL syndrome in these 15 patients included: thrombotic arteriolar microangiopathy (2 patients), stroke (4 patients), ocular ischemia (7 patients), deep vein thrombosis or pulmonary embolism (6 patients), renal artery or vein thrombosis (4 patients), peripheral ischemia (1 patient), and fetal wastage (3 patients). By comparison, among the 60 patients with normal aPL test results, only 5 patients had clinical events compatible with the aPL syndrome (P < 0.0001 by chi-squared test). aPLs may be associated with significant morbidity and mortality in patients with SLE undergoing renal transplantation. This study is the first attempt to quantify the impact of aPLs on renal transplantation in a large population of patients with SLE. Further investigation of aPLs in SLE patients with end-stage renal disease is required to clarify the risks, benefits, and optimal clinical management of renal transplantation for these patients.

Section snippets

Materials and methods

We performed a retrospective review of 96 patients with SLE who underwent renal transplantation at the University of California, San Francisco (UCSF) from January 1, 1984, to September 1, 1996. We chose this starting date because nearly all patients who underwent transplantation at UCSF since that time received either cyclosporine or tacrolimus (FK506) as part of their immunosuppressive regimen. Thus, they represent a relatively uniform group with respect to immunosuppression. Potential

Results

Ninety-nine patients were identified through the computer search and cross-check previously described. Three patients were excluded from the study because review of their records failed to confirm the diagnosis of SLE. The 96 remaining patients met at least four of the revised criteria for the classification of SLE8 or had pretransplantation renal biopsies that confirmed the diagnosis of SLE nephritis. The 96 patients underwent 104 renal transplantation procedures.

We obtained follow-up data on

Discussion

In this series of 96 consecutive patients with SLE who underwent renal transplantation at our institution from 1984 to 1996, we identified 10 cases of posttransplantation morbidity and/or mortality attributable to the aPL syndrome. In 8.5% of the SLE patients (8 of 96 patients) who received renal transplants during this time period, the aPL syndrome contributed directly to the loss of the graft. In contrast to findings from a smaller study,15 these data suggest that aPLs have a significant

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Received January 6, 1999; accepted in revised form June 25, 1999.

Address reprint requests to John H. Stone, MD, Division of Rheumatology, 1830 East Monument St, Suite 7500, Baltimore, MD 21205. E-mail: [email protected]

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