Antiphospholipid syndrome in renal transplantation |
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| Authors: | Thomas D Barbour Amy Crosthwaite Kevin Chow Moira J Finlay Nathan Better Peter D Hughes Solomon J Cohney |
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| Affiliation: | 1. Department of Nephrology, Royal Melbourne Hospital, , Melbourne, Victoria, Australia;2. Department of Anatomical Pathology, Royal Melbourne Hospital, , Melbourne, Victoria, Australia;3. Department of Nuclear Medicine, Royal Melbourne Hospital, , Melbourne, Victoria, Australia;4. Department of Nephrology & Medicine, Northwestern Academic Centre, University of Melbourne, , Melbourne, Victoria, Australia;5. Department of Epidemiology & Preventive Medicine, Monash University, , Melbourne, Victoria, Australia |
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| 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. |
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| Keywords: | antiphospholipid lupus plasma exchange thrombotic microangiopathy |
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