Plasmapheresis in a patient with antiphospholipid syndrome before living-donor kidney transplantation: a case report

BMC Nephrology

Masakazu Kohno¹  Yoshiyuki Kakehi³  Hiroaki Dobashi⁴  Masashi Inui⁵  Yoshio Kushida²  Nobufumi Ueda³  Kazuyo Kawakami¹  Taiga Hara¹  Yushi Hayashida³  Tadashi Sofue¹ 

[1] Division of Nephrology and Dialysis, Department of CardioRenal and Cerebrovascular Medicine, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa 761-0793, Japan;Department of Pathology, Kagawa University, Kagawa, Japan;Department of Urology, Kagawa University, Kagawa, Japan;Division of Endocrinology and Metabolism, Hematology, Rheumatology and Respiratory Medicine, Department of Internal Medicine, Kagawa University, Kagawa, Japan;Department of Urology, Tokyo Women’s Medical University, Yachiyo Medical Center, 477-96 Owada-Shinden, Yachiyo, Chiba 276-8524, Japan

关键词: Anti-β2-glycoprotein I IgG;    Plasmapheresis;    Living-donor kidney transplantation;    Antiphospholipid syndrome;   

Others  :  1082593
DOI  :  10.1186/1471-2369-15-167

 received in 2014-05-12, accepted in 2014-10-09,  发布年份 2014

【 摘 要 】

Background

Early graft thrombosis and bleeding complications remain important causes of early graft loss following kidney transplantation in patients with antiphospholipid syndrome. Anti-β2-glycoprotein I IgG is a disease-specific antibody in patients with antiphospholipid syndrome. Although plasmapheresis is partially effective for antibody removal, the optimal treatment allowing successful transplantation in patients with antiphospholipid syndrome has not been established. This is the first report of a patient with antiphospholipid syndrome who successfully underwent living-donor kidney transplantation following prophylactic plasmapheresis for removal of anti-β2-glycoprotein I IgG.

Case presentation

A 37-year-old Japanese female was scheduled to undergo a living-donor kidney transplant from her mother. At age 25 years, she experienced renal vein thrombosis, was diagnosed with antiphospholipid syndrome secondary to systemic lupus erythematosus, and was subsequently treated with prednisolone and warfarin. At age 37 years, she was diagnosed with end stage kidney disease, requiring maintenance hemodialysis because of recurrent renal vein thrombosis despite taking anticoagulation therapy. The pretreatment protocol consisted of prophylactic plasmapheresis plus full anticoagulation therapy to counteract the risks of early graft thrombosis. Anticardiolipin and anti-β2-glycoprotein I IgGs were successfully removed by both double filtration plasmapheresis and plasma exchange. The allograft kidney began to function soon after transplantation. No obvious thrombotic complications were observed after transplantation, although anti-β2-glycoprotein I IgG increased to the level observed before plasmapheresis. One year after transplantation, the patient’s kidney function remains stable while receiving anticoagulation therapy as well as a maintenance immunosuppressive regimen.

Conclusion

Prophylactic plasmapheresis plus full anticoagulation therapy may be an effective strategy in patients with antiphospholipid syndrome undergoing living-donor kidney transplantation.

【 授权许可】

   
2014 Sofue et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

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