James R Scott1, D Ware Branch, John Holman. 1. Department of Obstetrics and Gynecology, University of Utah Medical Center, Salt Lake City, UT 84132, USA.
Abstract
BACKGROUND: Immunosuppressive agents taken by pregnant organ transplant recipients readily cross the placenta during development of the fetal immune system. There are few data on the long-term implications for the progeny, but evidence from animal studies suggest that second and third generations of organ transplant patients may be at risk for autoimmune disorders and reproductive problems. METHODS: We present the 23-year-old daughter of a renal allograft recipient exposed to azathioprine 75 mg/day and prednisone 5 mg/day throughout her mother's pregnancy. RESULTS: During the daughter's first pregnancy, she developed multiple autoantibodies, Raynaud's phenomenon, and fetal death occurred at 20 weeks gestation. The second pregnancy was complicated by systemic lupus erythematosus, preeclampsia, and the birth of a preterm male infant. CONCLUSIONS: It is uncertain whether the autoimmune manifestations and obstetric complications in this patient were related to fetal exposure to immunosuppressive drugs. Nevertheless, further studies on the health and pregnancies of adult offspring of transplant patients are warranted.
BACKGROUND: Immunosuppressive agents taken by pregnant organ transplant recipients readily cross the placenta during development of the fetal immune system. There are few data on the long-term implications for the progeny, but evidence from animal studies suggest that second and third generations of organ transplant patients may be at risk for autoimmune disorders and reproductive problems. METHODS: We present the 23-year-old daughter of a renal allograft recipient exposed to azathioprine 75 mg/day and prednisone 5 mg/day throughout her mother's pregnancy. RESULTS: During the daughter's first pregnancy, she developed multiple autoantibodies, Raynaud's phenomenon, and fetal death occurred at 20 weeks gestation. The second pregnancy was complicated by systemic lupus erythematosus, preeclampsia, and the birth of a preterm male infant. CONCLUSIONS: It is uncertain whether the autoimmune manifestations and obstetric complications in this patient were related to fetal exposure to immunosuppressive drugs. Nevertheless, further studies on the health and pregnancies of adult offspring of transplant patients are warranted.
Authors: Monika Østensen; Munther Khamashta; Michael Lockshin; Ann Parke; Antonio Brucato; Howard Carp; Andrea Doria; Raj Rai; Pierluigi Meroni; Irene Cetin; Ronald Derksen; Ware Branch; Mario Motta; Caroline Gordon; Guillermo Ruiz-Irastorza; Arsenio Spinillo; Deborah Friedman; Rolando Cimaz; Andrew Czeizel; Jean Charles Piette; Ricard Cervera; Roger A Levy; Maurizio Clementi; Sara De Carolis; Michelle Petri; Yehuda Shoenfeld; David Faden; Guido Valesini; Angela Tincani Journal: Arthritis Res Ther Date: 2006-05-11 Impact factor: 5.156