Factor v R506q Mutation (Activated Protein C Resistance) Is an Additional Risk Factor for Early Renal Graft Loss Associated With Acute Vascular Rejection

Ekberg, Henrik; Svensson, Peter; Simanaitis, Mečislovas; Dahlbäck, Björn

doi:10.1097/00007890-200004270-00010

Cited by 39 publications

(29 citation statements)

References 24 publications

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“…As major reasons the occurrence of acute rejections, probably mostly vascular rejections, has been described (6,8,10). Furthermore, rates of early graft loss due to venous thromboembolism and graft perfusion defects were significantly elevated in patient groups tainted with thrombophilia (11).…”

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confidence: 99%

Outcome of Kidney Transplantation in Patients with Inherited Thrombophilia

Heidenreich

Junker²,

Lang³

et al. 2003

Journal of the American Society of Nephrology

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Abstract. Inherited prothrombotic risk factors predispose patients to thromboembolic events. In kidney transplant recipients, thrombophilia may manifest itself with venous thrombosis, microvascular occlusion, or acute rejection with major consequences for allograft survival. This is a prospective study on 165 renal allograft recipients to evaluate the contribution of genetic thrombophilic risk factors to transplant outcome. Besides antithrombin, protein C, and protein S deficiencies, none of which was found in our patient group, factor V G1691A (FV G1691A), prothrombin G20210A (PT G20210A) mutations, and methylenetetrahydrofolate reductase (MTHFR) gene C677T polymorphisms were studied. The primary endpoint of the study was occurrence of an acute rejection within the first 90 d and transplant loss within 1 yr. Heterozygous FV G1691A and PT G20210A mutations and the MTHFR T677T variant were significantly associated with acute rejections with rejection rates of 68%, 67%, and 71%, respectively, as compared with 35% in patients not carrying these genotypes. Many rejections that were histologically proven were acute vascular ones. Transplant loss was significantly associated exclusively with the PT G20210A group (50% 1-yr graft survival; odds ratio, 10.0; 95% confidence interval, 1.8 to 56.1). PT G20210A patients exerted the highest prothrombotic activity pretransplant, as determined by prothrombin 1.2 fragments (PT F1.2), which may be the background for minor outcome. In conclusion, common prothrombotic mutations are significantly associated with acute rejections, especially vascular rejections, and for PT G20210A also with early transplant failure. Screening for hypercoagulable states pretransplant is recommended to intensify anticoagulatory treatment posttransplant. heidenr@uni-muenster.de

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confidence: 99%

Outcome of Kidney Transplantation in Patients with Inherited Thrombophilia

Heidenreich

Junker²,

Lang³

et al. 2003

Journal of the American Society of Nephrology

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“…Also FVL carriers had 12-fold higher risk of an early graft perfusion defect (Wuthrich, 2001). A higher risk of vascular rejection was found in FVL carriers, which was linked to the presence of endotheliolitis or fibrinoid necrosis on histopathology of renal grafts lost within the first year after transplant (Ekberg, 2000). The reported prevalence of prothrombin gene heterozygous mutation in renal transplant recipients is 3.7%, similar to that in the general population.…”

Section: Thrombophiliasmentioning

confidence: 82%

Vascular Complications in Kidney Transplantation

Giakoustidis¹,

Antoniadis²,

Giakoustidis³

2011

Understanding the Complexities of Kidney Transplantation

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“…14 Ekberg and associates found that acute rejection in recipients with factor V R506Q mutation experienced early graft loss because of vascular rejection of the graft attributed to histologic changes including endotheliosis and fibrinoid vascular changes associated with FV genotype. 6 Studies have shown that recipients with hypercoagulable disorders have a significantly higher risk of early graft failure apart from thromboembolic events and acute rejection. 16 Long-term graft survival is higher when anticoagulants are administered prophylactically.…”

Section: Discussionmentioning

confidence: 99%

“…5 Early graft loss within the first year after transplant was 55.6%. 2,6 Delayed graft function and chronic graft dysfunction also have been reported.…”

Section: Introductionmentioning

confidence: 99%

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Florou

Koukoulaki²,

Theodoros³

et al. 2017

Exp Clin Transplant

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Thrombophilia due to activated protein C resistance (Leiden mutation) is the most common inherited thrombophilic disorder with 5% incidence in whites. Renal transplant of these patients entails a risk of vascular thrombosis soon after the transplant; and acute rejection episodes and graft loss within the first year. We present a case of a successful living-related renal transplant in man with a recent history of repeat episodes of vascular access thrombosis attributed to inherited thrombophilia (heterozygosity for factor V mutation Q506 and homozygosity for mutation T677 for methylenetetrahydrofolate reductase). Transplant recipient was administered anticoagulation therapy with low molecular weight heparin pre-and postoperatively. No thrombotic or hemorrhagic events occurred posttransplant. A high suspicion of thrombophilic disorders in patients with end-stage renal disease with vascular access thrombotic events should be screened further to prevent failure of a subsequent renal transplant. Inherited thrombophilic disorders may not exclude living-related kidney transplant provided that anticoagulation therapy is administered perioperatively.

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Factor v R506q Mutation (Activated Protein C Resistance) Is an Additional Risk Factor for Early Renal Graft Loss Associated With Acute Vascular Rejection

Cited by 39 publications

References 24 publications

Outcome of Kidney Transplantation in Patients with Inherited Thrombophilia

Outcome of Kidney Transplantation in Patients with Inherited Thrombophilia

Vascular Complications in Kidney Transplantation

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