Marion Rabant 1 MD, Canaud G 2 MD, François A 3 MD, Noël LH 1 MD (1)Pathology Department, Necker Hospital, Paris, France (2)Transplantation Department, Necker Hospital, Paris, France (3) Pathology Department, Rouen Hospital, Rouen, France Severe vascular lesions and poor functional outcome in a kidney transplant recipient CASE 4
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Marion Rabant 1 MD, Canaud G 2 MD, François A 3 MD, Noël LH 1 MD (1)Pathology Department, Necker Hospital, Paris, France (2)Transplantation Department,
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Marion Rabant1 MD, Canaud G2 MD, François A3 MD, Noël LH1 MD
Antiphospholipid syndrom (APS) and kidneyAntiphospholipid syndrom (APS) and kidney
Definition (Sydney criteria, 2006): 1 clinical and 1 biological criteria
Clinical:•1 episode of arterial, venous, or small vessel thrombosis•1 or more unexplained deaths of a normal fetus <10th week and/or•3 or more unexplained consecutive spontaneous abortions <10th•1 or more premature birth of a morphologically normal neonate <34th week of gestation due to eclampsia or severe pre-eclampsia
Biological (on 2 or more occasions)•Anti-cardiolipin IgG and/or IgM•Anti-β2 glycoprotein I IgG and/or IgM•Lupus anticoagulant
Primary or secondary (autoimmune disease such as SLE)
Antiphospholipid syndrom (APS) and kidneyAntiphospholipid syndrom (APS) and kidney
Primary antiphospholipid syndrome presenting as renal vein thrombosis and membranous nephropathy. Chaturvedi S. Pediatr Nephrol. 2011 Jun;26(6):
Several cases of MN
Anticardiolipin antibody and renal disease: a report of 3 cases. D’Agati. JASN 1:777-784, 1990
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APS and kidney transplantationAPS and kidney transplantation
1359 transplantations (January 1, 2000 and Decembre 31, 2009)
AP antibodies (APA+)n=37 (2,7%)
APS n=12
Primary APSn=3
Secondary APSN=9
APA+n=25
• Lupus anticoagulantn=37/37 (100%)• Anti β2GP1 (n=7/37)• Anti CL (n=11/37)
Compared to 59 matched APA- transplant recipients
Canaud G, et al
To assess the long term clinical and histological significance of APA+ and APS
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cv ah
ci ct
cv ah
ci ct
APS and kidney transplantationAPS and kidney transplantation
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Vascular lesions and humoral rejectionVascular lesions and humoral rejection
Between M3 and M12
Mean Banff cv score
DSA+ (n=40) : 0.65 ±0.11 to 1.12± 0.10, P=0.014
DSA - (n=59): 0.65 ± 0.11 to 0.81±0.10, P=ns
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CONCLUSIONCONCLUSION
Antiphospholipid syndrome is a severe disease with o More thromboembolic events after transplantationo Poor graft outcomeo Recurrence of APS nephropathy o Progression of IF/TA
Importance of screening APA in case of thromboembolic events
High risk renal transplantation in APS patients
DSA and humoral rejection may have contributed to accelerate vascular lesions