부산대학교 도서관

BACKGROUND: Graft thrombosis is a devastating complication after renal transplantation. In a monocenter study, we recently described the association of antibodies anti Beta-2-Glycoprotein-I (IgA-ab2GP1) with early graft loss mainly by thrombosis. METHODS: We performed a multicenter study including 740 patients of five hospitals of the Spanish Forum Renal Group transplanted from 2000-2002 and prospectively followed for ten years. The presence of IgA-aB2GP1 in pretransplant serum was retrospectively examined. RESULTS: At transplantation 288 patients were positive for IgA-B2GP1 (29%, 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) and vessel thrombosis was the most frequent cause of early graft loss, especially in Group-1 (6.9% vs 0.4% p <0.001). Of note, IgA-aB2GP1 was the most important independent risk factor for graft thrombosis (OR: 5.05; 95% CI: 3.05 to 8.35, p <0.001). In addition, the presence of IgA-aB2GP1 was associated with early graft loss and delayed graft function. Survival figures were also lower in Group-1. At ten years, non-censored graft survival was lower in Group-1 compared with Group-2 (60.4% vs 76.8% p<0.001) and mortality was significantly higher in Group 1 (19.8 % vs 12.2%, p=0.005). CONCLUSIONS: In a prospective multicenter study, we have been able to corroborate that pre-transplant presence of IgA-aB2GP1 was the main risk factor for graft thrombosis and early graft loss. Therefore, a prospective study to evaluate the efficacy and safety of prophylactic anticoagulation to avoid this severe complication is mandatory.