Kidney Week

Abstract: TH-PO1009

Secondary Antiphospholipid Syndrome Is Associated with Worse Kidney Allograft Outcomes in Transplant Recipients with Systemic Lupus Erythematosus

Session Information

• Transplantation: Clinical - Outcomes, Malignancy, and Pathology
  October 22, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Transplantation

• 2002 Transplantation: Clinical

Authors

• Reyes-Moreno, Juan-Esteban, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, CDMX, Mexico

Juan-Esteban Reyes-Moreno

• Badillo Montufar, Luisa Maely, Tecnologico de Monterrey - Campus Ciudad de Mexico, Mexico City, CDMX, Mexico

Luisa Maely Badillo Montufar

• Amador Gómez, Daira Estephania, Tecnologico de Monterrey - Campus Ciudad de Mexico, Mexico City, CDMX, Mexico

Daira Estephania Amador Gómez

• Matías Martinez, Melvin Barish, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, CDMX, Mexico

Melvin Barish Matías Martinez, MD

• Santos, Julio Cesar, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, CDMX, Mexico

Julio Cesar Santos, MD

• Morales-Buenrostro, Luis E., Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, CDMX, Mexico

Luis E. Morales-Buenrostro, MD, PhD

• Mejia-Vilet, Juan M., Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, CDMX, Mexico

Juan M. Mejia-Vilet, MD, PhD

Background

Antiphospholipid syndrome (APS) is an autoimmune disease associated with thrombotic complications and organ damage. However, its impact on kidney transplant outcomes in systemic lupus erythematosus (SLE) remains incompletely characterized. We compared renal allograft outcomes between transplanted SLE patients with and without secondary APS.

Methods

We conducted a retrospective cohort study including consecutive SLE patients who underwent kidney transplantation between 2000 and 2025. Patients were stratified into SLE/APS[+] and SLE/APS[-] groups. Demographic characteristics, comorbidities, transplant-related variables, histopathology, and longitudinal outcomes were collected. Outcomes included allograft survival, biopsy-proven thrombotic microangiopathy (TMA), rejection, and patient survival. All outcomes were assessed by survival analyses (time-to-event).

Results

A total of 130 SLE kidney transplant patients were included, median age was 34 years (IQR 27-42), 105 (81%) were female, 68 (52%) received living-donor transplants, and 62 (48%) deceased-donor transplants. Fourteen patients (11%) had secondary APS. Baseline characteristics, transplant variables, and immunosuppressive treatments were similar between groups. Over a median follow-up of 93 months (IQR 38-155), allograft failure was significantly higher in SLE/APS[+] versus SLE/APS[-] patients (HR 4.53, 95% CI 1.40-14.6, p=0.012). SLE/APS[+] patients also developed TMA earlier and more frequently (HR 12.8, 95% CI 3.64-45.1, p<0.001) and had higher mortality (HR 4.52, 95% CI 1.12-18.2, p=0.034). Rates of rejection, lupus nephritis recurrence, and infectious complications were similar between groups.

Conclusion

Secondary APS in SLE kidney transplant recipients is associated with increased risks of allograft loss, TMA, and mortality. No differences were found in rates of rejection, lupus nephritis recurrence, and infectious complications. These findings support the need for closer surveillance in this high-risk population.

Acknowledgment

None

Figure 1. Time to thrombotic microangiopathy events (A) and allograft survival (B) in the study cohort.