Renal thrombotic microangiopathy associated with anticardiolipin antibodies in hepatitis C-positive renal allograft recipients

Détails

ID Serval
serval:BIB_74FE007ED69C
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Titre
Renal thrombotic microangiopathy associated with anticardiolipin antibodies in hepatitis C-positive renal allograft recipients
Périodique
Journal of the American Society of Nephrology
Auteur(s)
Baid  S., Pascual  M., Williams, W. W., Jr. , Tolkoff-Rubin  N., Johnson  S. M., Collins  B., Chung  R. T., Delmonico  F. L., Cosimi  A. B., Colvin  R. B.
ISSN
1046-6673
Statut éditorial
Publié
Date de publication
01/1999
Peer-reviewed
Oui
Volume
10
Numéro
1
Pages
146-53
Notes
Comparative Study
Journal Article
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, P.H.S. --- Old month value: Jan
Résumé
Hepatitis C virus (HCV) infection has been associated with de novo or recurrent membranoproliferative glomerulonephritis and acute transplant glomerulopathy in transplanted kidneys. Recently, anticardiolipin antibodies (ACA) have been linked with chronic HCV infection. A few reports have suggested an association between ACA and renal allograft thrombosis. This study examines the clinical and pathologic features of HCV-positive renal allograft recipients at our institution. From 1990 to 1996, 379 kidney transplants were performed. We identified 18 recipients (4.8%) with HCV-positive serology pretransplant. Determination of IgG and IgM ACA was performed by enzyme-linked immunosorbent assay, using pretransplant sera. Among the 18 patients, five patients presented with biopsy-proven de novo renal thrombotic microangiopathy (RTMA), occurring 5 to 120 d (median, 14 d) after transplant. No differences in pretransplant characteristics were observed between patients with (n = 5) or without (n = 13) RTMA. All five patients had a positive ACA test (either IgG or IgM titer > 2 SD above normal), compared with only one of 13 patients without RTMA. The mean value for IgG ACA was significantly higher in the RTMA patients than in patients without RTMA (22.9 +/- 14.1 versus 6.9 +/- 4.9 IgG phospholipid units, P = 0.02); however, there were no significant differences in IgM ACA titers. Rheumatoid factor and complement C4 levels were normal in pretransplant sera of patients with RTMA. Patients with RTMA had their cyclosporine withdrawn (four of five) or the dose was decreased (one of five), and one of five underwent plasmapheresis. Four of five patients died within 5 yr after transplant, compared with no deaths in the other 13 patients. Finally, as a control group, seven HCV-negative renal allograft recipients who presented with RTMA/hemolytic uremic syndrome during the same time period were found to have normal ACA values (IgG or IgM). RTMA associated with ACA in HCV-positive renal allograft recipients may represent a new clinical entity. The occurrence of this syndrome may have deleterious consequences for patient and graft survival.
Mots-clé
Adult Antibodies, Anticardiolipin/*blood Female Hemolytic-Uremic Syndrome/blood Hepatitis C/blood/*complications/virology Humans Kidney/blood supply/immunology Kidney Transplantation/*adverse effects Male Microcirculation/pathology Middle Aged *Renal Artery/immunology Venous Thrombosis/blood/*etiology/therapy
Pubmed
Web of science
Création de la notice
29/01/2008 14:52
Dernière modification de la notice
03/03/2018 18:22
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