The Significance of Antiphospholipid Antibodies in Liver Recipients

• Published in: Transplantation proceedings 2013-06, Vol.45 (5), p.1983-1989
• Main Authors: Furmańczyk-Zawiska, A, Tronina, O, Ba̧czkowska, T, Chmura, A, Durlik, M
• Format: Article
• Language: English
• Subjects: Adult; Aged; Antibodies, Antiphospholipid - blood; Female; Humans; Liver Transplantation; Male; Middle Aged; Surgery; Young Adult
• ISSN: 0041-1345; 1873-2623
• DOI: 10.1016/j.transproceed.2013.01.024

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-β2 GPI), 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-β2 GPI 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-β2 GPI 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.