Liver transplantation
Complications
The Significance of Antiphospholipid Antibodies in Liver Recipients

https://doi.org/10.1016/j.transproceed.2013.01.024Get rights and content

Abstract

Background

The presence of antiphospholipid antibodies (APLAs) may be associated with increased thrombotic risk. Liver graft thrombosis may necessitate retransplantation.

Aim

To determine the prevalence of APLAs among liver recipients and to investigate the relationship between APLAs and liver graft thrombosis.

Materials and methods

We included 33 Caucasian patients aged 22 to 75 years who displayed stable liver graft function (21 women and 12 men). The patients were divided into 2 subgroups: high thrombotic risk subgroup T(−) and at low risk T(+) subgroups. The T(−) included 25 patients, T(+) included 8 recipients with a history of severe thrombosis. We investigated: lupus anticoagulant, anticardiolipin antibodies (aCL), anti-β2-glycoprotein I antibodies (anti-β2GPI), antiprothrombin antibodies (immunoglobulin (Ig)G and IgM isotype), protein C and S activities, factor VIII, antithrombin, ADAMTS-13 and anti-ADAMTS-13. The 2 determinations were performed at an interval of 6 months. The mean follow-up was 19.5 ± 4.6 months.

Results

The most commonly detected antibodies were anti-β2GPI IgM (25%) and aCL IgG (15.63%). Comparing the prevalence of APLAs between T(−) and T(+), we observed a significant difference only for aCL IgM (P = .0183), which was not confirmed on a second determination after 6 months. We noted correlations between aCL IgM and number of thrombotic episodes (P = .0040) and between aCL IgM and anti-β2GPI IgM (P = .0074; rho 0.45). Despite receiving low-molecular-weight heparin or aspirin recurrence of thrombosis occurred in 4 T(+) patients: 3 hepatic artery thrombosis and 1 splenic artery thrombosis. Only 1 patient had APLAs; the other 2, protein C or S deficiency and the fourth, a normal test.

Conclusions

The prevalence of APLAs in liver recipients is greater than that in the general population. The usefulness of APLAs as a marker of thrombosis was not demonstrated suggesting multifactorial etiologies of liver graft thrombosis.

Section snippets

Materials and Methods

We examined 33 Caucasian recipients of deceased-donor liver transplantation including 21 women and 12 men who displayed stable graft function. Their overall mean age was 44.7 ± 14.1 years. The mean interval between liver transplantation and beginning the study (assessment 1) was 33.9 ± 27.5 months and the mean interval between historical thrombosis (thrombosis 1) and assessment 1 was 38.6 ± 36.5 months. A subgroup of patients was identified who were free of a history of significant thrombotic

Results

The prevalence of APLAs in liver transplant patients was higher than that in the general population, ranging from 0% to 25% depending on the APLA type. The most common antibodies were anti-β2GPI IgM antibodies (21.21% at assessment 1 and 25% at assessment 2; Table 1). When we compared the prevalence of individual APLA types, we noticed a significant difference in aCL between the T(−) and T(+) subgroup at assessment 1 (P = .0183). This finding was not, however, confirmed at assessment 2 6 months

Discussion

APLAs in liver transplant patients have been the subject of isolated reports in the literature.4 According to the most recent data, aCL are observed among 8.5% of liver transplant patients.1 Collier et al reported a 6.3% prevalence of aCL IgG among all liver transplant patients and 8.8% among those who develop HAT.5 According to other authors, high APLA levels in patients awaiting liver transplantation return to normal as early as 1 month following liver transplantation.4 In our study, the

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    Citation Excerpt :

    The prevalence of aPL in the general population was reported to be 1% to 5% [10]. In a recent study, the prevalence of anti-β2GPI IgM and aCL IgG antibodies was reported to be 25% and 15.6%, respectively, in 33 recipients who underwent OLT [11]. However, the prevalence of aPL positivity was derived from relatively small studies on patients who underwent OLT.

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