β2-Glycoprotein I/IgA Immune Complexes: A Marker to Predict Thrombosis After Renal Transplantation in Patients With Antiphospholipid Antibodies
Identificadores
URI: http://hdl.handle.net/20.500.12020/1290ISSN: 0009-7322
DOI: https://doi.org/10.1161/CIRCULATIONAHA.116.025992
Autor/es
Serrano, Manuel; martinez-flores, jose angel; Garcia, Florencio; cabrera, Oscar; Pleguezuelo, Daniel; [et al.]Fecha
2017Tipo de documento
articleÁrea/s de conocimiento
Ciencias BiomédicasMateria/s Unesco
32 Ciencias MédicasResumen
BACKGROUND: Antiphospholipid syndrome is characterized by recurrent
thrombosis and gestational morbidity in patients with antiphospholipid
autoantibodies (aPLs). Predictive value of the presence of aPLs is low,
and new markers are necessary to identify aPL carriers at higher risk and
take preventive measures on them. The presence of circulating immune
complexes of IgA bound to β2-glycoprotein I (B2A-CIC) has been associated
with occurrence of acute thrombotic events. In this work we study its
possible predictive value for the appearance of acute thrombotic events in
patients who are going to undergo transplant surgery, a well-known trigger
of acute thrombotic events in aPL carriers.
METHODS: We performed a follow-up study based on the Magnum 12+12
Cohort of patients who received a kidney transplant (n=1339). Three
groups were established: group 1 patients who were positive for IgA anti-β2-
glycoprotein I (aB2GP1) and B2A-CIC (n=125); group 2 patients who were
positive only for IgA aB2GP1 (n=240); and control group, patients who
were negative for IgA aB2GP1 (n=974). Levels of autoantibodies and B2A-
CIC were quantified immediately before the transplant surgery and patients
were followed up for 6 months.
RESULTS: In group 1, 46.4% of patients experienced any type of
thrombosis versus 10.4% in group 2 (P<0.001) and 8.6% in the control
group (P<0.001). The incidence of graft thrombosis in group 1 (31.2%)
was significantly higher than that observed in group 2 (3.3%, P<0.001)
and the control group (2.6%, P<0.001). In a multivariate analysis, the
presence of B2A-CIC was an independent variable to experience any
type of posttransplant thrombosis (hazard ratio, 6.72; 95% confidence
interval, 4.81–9.37) and, prominently, for graft thrombosis (hazard
ratio, 14.75; 95% confidence interval, 9.11–23.89). No significant
differences were found between B2A-CIC–negative and control group
patients.
CONCLUSIONS: The presence of B2A-CIC is a predictor of acute
thrombotic events. Patients who were positive for IgA aB2GP1 only are
at risk of experiencing thrombosis if they are B2A-CIC positive. If they are
B2A-CIC–negative patients, they have the same risk as the control group.
Treatments to prevent acute thrombotic events should focus on B2A-CIC–
positive patients.