Ten-yr renal allograft survival of patients with antiphospholipid antibody syndrome

Background: Long-term allograft survival of antiphospholipid antibody syndrome (APAS) patients as well as patients who have antiphospholipid antibodies but no thrombotic complications remains largely unknown. This study evaluates long-term allograft survival of APA as well as patients with APAS. Methods: During the study period from January 1, 1992 through May 31, 2009, 1625 patients with ESRD awaiting renal transplants were screened for APAS. Ninety-four (5.8%) of these patients had circulating levels of anticardiolipin antibodies (ACA) and 39 of these patients had documented evidence of clotting disorders and were diagnosed with APAS. Twenty-one patients with APAS received transplants on either low molecular weight (LMW) heparin or Coumadin as anticoagulation therapy. Of 94 patients with only ACA, 46 received renal transplants. Of the remaining 1492 patients, 1285 patients with no evidence of either ACA or APAS received renal transplants. Results: Ten-yr allograft survival of patients with APAS treated with Coumadin was similar to those treated with LMW heparin (18% vs. 20%, NS). However, those allograft survivals were significantly lower than those patients positive for ACA (28%) alone (ACA vs. LMW heparin or Coumadin p = 0.0001). Conclusion: Despite anticoagulation therapies, patients with APAS have lower long-term graft survival than those patients who have circulating ACA but no APAS.