Significance of anticardiolipin antibodies on short and long term allograft survival and function following kidney transplantation
Significance of anticardiolipin antibodies on short and long term allograft survival and function following kidney transplantation
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DOI：
10.1046/j.1600-6143.2004.00602.x
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发表时间：
2004-11-01
影响因子：
8.8
通讯作者：
Tolkoff-Rubin, N
中科院分区：
文献类型：
--
作者：
Forman, JP;Lin, J;Tolkoff-Rubin, N
肾移植前抗心磷脂抗体（ACA）的意义尚不清楚。我们研究了1996年至2001年接受肾移植的337例患者。随访持续至同种异体移植物丢失、患者死亡或2002年12月31日。主要结局是死亡删失的同种异体移植物丢失或移植后1个月估计肾小球滤过率（GFR）降低25%的复合终点。次要结局为1年时同种异体移植物丢失、GFR降低25%、急性排斥反应和肌酐。18.1%的受者IgG和IgM ACA滴度≥ 15。除了在ACA滴度阳性的患者中使用香豆素治疗（20%对7.4%）外，接受者之间在基线时没有显著差异。移植后，ACA阳性患者的主要结局没有增加，即使在调整香豆素抗凝治疗后也是如此（HR = 1.42 [0.68，2.96]）。有或没有阳性滴度之间的次要结果没有差异。5例滴度非常高（>50）且未抗凝的患者中有2例发生早期移植物丢失。肾移植前ACA滴度阳性与移植后肾脏预后不良无关，尽管需要更多的研究来解决非常高的ACA滴度的预后意义。
The significance of anticardiolipin antibodies (ACAs) prior to renal transplantation is unclear. We studied a cohort of 337 patients who underwent renal transplantation from 1996 to 2001. Follow-up continued until allograft loss, patient death or 31 December 2002. The primary outcome was a composite endpoint of death-censored allograft loss or a 25% reduction in estimated glomerular filtration rate (GFR) from 1-month post-transplant. Secondary outcomes were allograft loss, a 25% reduction in GFR, acute rejection and creatinine at 1 year. IgG and IgM ACA titers were positive (greater than or equal to15) in 18.1% of recipients. There were no significant differences at baseline between recipients, except coumadin therapy in those with positive ACA titers (20% vs. 7.4%). Post-transplant, there was no increase in the primary outcome in ACA-positive patients, even after adjustment for anticoagulation with coumadin (HR = 1.42 [0.68, 2.96]). There was no difference in secondary outcomes between those with or without positive titers. Two of five patients with very high titers (>50) who were not anticoagulated had early graft loss. A positive ACA titer prior to kidney transplantation was not associated with inferior renal outcomes after transplantation, although more research is required to address the prognostic significance of very high ACA titers.