Antiphospholipid syndrome in renal transplantation

Thomas D Barbour, Amy Ashton Crosthwaite, Kevin Chow, Moira Finlay, Nathan Better, Peter D Hughes, Solomon Jonathan Cohney

Research output: Contribution to journalArticleOther

11 Citations (Scopus)

Abstract

Antiphospholipid syndrome (APS) may occur in isolation or in association with systemic lupus erythematosus (SLE), with the potential to cause renal failure via several distinct pathologies. Renal transplantation in the presence of APS carries a risk of early graft loss from arterial or venous thrombosis, or thrombotic microangiopathy (TMA). Whilst perioperative anticoagulation reduces the risk of large vessel thrombosis, it may result in significant haemorrhage, and its efficacy in preventing post-transplant TMA is uncertain. Here, we report a patient with end-stage kidney disease (ESKD) due to lupus nephritis and APS, in whom allograft TMA developed soon after transplantation despite partial anticoagulation. TMA resolved with plasma exchange-based therapy albeit with some irreversible graft damage and renal impairment. We discuss the differential diagnosis of post-transplant TMA, and current treatment options. Summary at a Glance This review considers the clinical presentation and management of antiphospholipid syndrome, specifically the renal manifestations and considerations around kidney transplantation.
Original languageEnglish
Pages (from-to)177 - 185
Number of pages9
JournalNephrology
Volume19
Issue number4
DOIs
Publication statusPublished - 2014

Cite this

Barbour, T. D., Crosthwaite, A. A., Chow, K., Finlay, M., Better, N., Hughes, P. D., & Cohney, S. J. (2014). Antiphospholipid syndrome in renal transplantation. Nephrology, 19(4), 177 - 185. https://doi.org/10.1111/nep.12217