Eculizumab to Enable Renal Transplantation in Patients With History of Catastrophic Antiphospholipid Antibody Syndrome
Eculizumab to Enable Renal Transplantation in Patients With History of Catastrophic Antiphospholipid Antibody Syndrome
Catastrophic Antiphospholipid Antibody Syndrome (CAPS) is a rare condition in which
 life-threatening blood clots form in multiple organs simultaneously and can lead to
 multi-organ system failure and death. The causes of CAPS are not entirely understood, but
 CAPS episodes are often triggered by stressful events such as infections, surgery, or trauma.
 For patients who survive an episode of CAPS, permanent kidney failure is not uncommon because
 the kidneys are the organ system most frequently affected in CAPS. Kidney transplantation is
 the treatment of choice for end-stage kidney disease, but patients with a history of CAPS are
 exceptionally high-risk kidney transplant recipients because the chance that surgery itself
 could trigger a life-threatening or transplant-threatening episode of CAPS is significant. As
 a result, patients with CAPS are not generally considered candidates for transplantation.
 Despite this, these patients have a severely decreased life-expectancy on dialysis and their
 long-term survival and quality of life would be greatly increased by a successful kidney
 transplant. In this trial, a drug called eculizumab will be tested for its ability to prevent
 CAPS after kidney transplantation in patients with a prior history of CAPS. Eculizumab is an
 inhibitor of the complement system, which is believed to be important in generating the
 inflammatory environment that leads to diffuse clotting of blood vessels in CAPS. The
 investigators hypothesize that by blocking the complement cascade using eculizumab, in
 conjunction with blocking the coagulation system, that kidney transplantation can be safely
 and successfully performed in patients with a history of CAPS.
Inclusion Criteria:

 -  Age 18 years or older

 -  History of Catastrophic Antiphospholipid Antibody Syndrome (CAPS)

 -  End-stage renal disease

 Exclusion Criteria:

 -  Any contraindications to transplantation other than CAPS

 -  Pregnant women

 -  Women who intend to become pregnant over the study period

 -  Ongoing or untreated meningococcal infections

 -  History of serious adverse reaction to eculizumab