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Title: Antiphospholipid syndrome in renal transplantation.
Authors: Cohney, Solomon (Shlomo)
Other Authors: Barbour, Thomas
Crosthwaite, Amy
Chow, Kevin
Finlay, Moira
Better, Nathan
Hughes, Peter
Keywords: Anticoagulants
Therapeutic Use
Antiphospholipid Syndrome
Drug Therapy
Diagnosis, Differential
Kidney Failure, Chronic
Kidney Transplantation
Adverse Effects
Lupus Nephritis
Plasma Exchange
Predictive Value of Tests
Thrombotic Microangiopathies
Treatment Outcome
Systemic Lupus Erythematosus
Renal Transplantation
End-Stage Kidney Disease
UroRenal, Vascular Clinical Institute, Epworth HealthCare, Victoria, Australia
Department of Nephrology, Epworth HealthCare, Richmond, Victoria, Australia.
Department of Gastroenterology, Epworth HealthCare, Richmond, Victoria, Australia.
Issue Date: Apr-2014
Publisher: Wiley
Citation: Nephrology (Carlton). 2014 Apr;19(4):177-85.
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.
DOI: 10.1111/nep.12217
PubMed URL:
ISSN: 1440-1797
Journal Title: Nephrology (Carlton)
Type: Journal Article
Affiliated Organisations: Department of Nephrology, Royal Melbourne Hospital, Melbourne, Victoria, Australia.
Department of Anatomical Pathology, Royal Melbourne Hospital, Melbourne, Victoria, Australia.
Department of Nuclear Medicine, Royal Melbourne Hospital, Melbourne, Victoria, Australia.
Department of Nephrology & Medicine, Northwestern Academic Centre, University of Melbourne, Melbourne, Victoria, Australia.
Department of Epidemiology & Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
Type of Clinical Study or Trial: Case Reports
Appears in Collections:UroRenal, Vascular

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