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Chokri Ben Lamine: Antiphospholipid Syndrome After Kidney Transplantation
Chokri Ben Lamine/X
Aug 26, 2026, 16:53

Chokri Ben Lamine: Antiphospholipid Syndrome After Kidney Transplantation

Chokri Ben Lamine, Hematologist at King Faisal Specialist Hospital and Research Center, shared a post on X about a recent article by Agnieszka Furmańczyk-Zawiska et al., published in Journal of Clinical Medicine, adding։

”Antiphospholipid syndrome after kidney transplantation

APS increases the risk of:

  • Early graft thrombosis
  • Thrombotic microangiopathy
  • Stroke or venous thromboembolism
  • Recurrent graft loss
  • Catastrophic antiphospholipid syndrome

Multicenter cohort:

  • APS: 19 recipients
  • Controls: 21
  • 15-year graft survival: 73.9 percent vs 90.5 percent
  • Mean graft duration: 11.2 vs 14.4 years
  • Both were significantly inferior with APS.

Outcomes were particularly poor when APS was diagnosed only after transplantation:

First-graft survival: 0 percent

69 percent when APS was recognized before transplantation

Early recognition enables peri-transplant thromboprophylaxis and closer monitoring.

Thrombosis–bleeding dilemma

Despite anticoagulation:

Recurrent thrombosis: 6 of 19 patients

Thrombotic microangiopathy: 2 patients

Stroke: 2 patients

Venous thromboembolism: 1 patient

Arteriovenous fistula thrombosis: 1 patient

Meanwhile, bleeding complicated thromboprophylaxis in 5 of 19 patients.

Practical anticoagulation approach

Vitamin K antagonist: target INR 2–3

Alternatively, renal-adjusted low-molecular-weight heparin with anti-Xa monitoring

For invasive procedures: interrupt oral anticoagulation and consider carefully controlled heparin bridging

Avoid direct oral anticoagulants in triple-positive APS or arterial APS

Who should undergo antiphospholipid antibody testing before transplantation?

  • Candidates with systemic lupus erythematosus
  • Previous arterial or venous thrombosis
  • Recurrent vascular-access thrombosis
  • Pregnancy morbidity suggestive of APS
  • Unexplained prior graft thrombosis or thrombotic microangiopathy

This is targeted screening, not established universal screening for every candidate.

Suspect catastrophic APS when rapid multiorgan thrombosis occurs after surgery, infection, rejection or anticoagulation interruption

Treatment may include:

  • Therapeutic heparin
  • Corticosteroids
  • Plasma exchange
  • Intravenous immunoglobulin
  • Rituximab or complement inhibition in selected refractory cases

Bottom line:

Kidney transplantation remains the preferred renal-replacement strategy in APS, but success requires pre-transplant diagnosis, individualized anticoagulation, bleeding surveillance, antiphospholipid-antibody monitoring and multidisciplinary follow-up.

Evidence limitation: retrospective study with only 19 APS recipients; findings are clinically important but not definitive.”

Title: Antiphospholipid Syndrome in Renal Allograft Recipients-A Long-Term Multicenter Analysis

Authors: Agnieszka Furmańczyk-Zawiska, Barbara Bułło-Piontecka, Michał Komorniczak, Alicja Dębska-Ślizień, Hanna Augustyniak-Bartosik, Magdalena Durlik

Chokri Ben Lamine: Antiphospholipid Syndrome After Kidney Transplantation

Other posts featuring Chokri Ben Lamine on Hemostasis Today.

Agnieszka Furmańczyk-Zawiska Alicja Dębska-Ślizień Antiphospholipid Syndrome Barbara Bułło-Piontecka Chokri Ben Lamine Hanna Augustyniak-Bartosik Health Hematology Hemostasis Hemostasis News Hemostasis Today Magdalena Durlik Medicine Michał Komorniczak
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