Anne Laure Hebral1, Olivier Cointault1, Laure Connan2, Nicolas Congy-Jolivet3, Laure Esposito1, Isabelle Cardeau-Desangles1, Arnaud Del Bello4, Laurence Lavayssière1, Marie Béatrice Nogier1, David Ribes1, Joelle Guitard1, Federico Sallusto5, Xavier Gamé6, Olivier Parant7, Alain Berrebi2, Lionel Rostaing8, Nassim Kamar8. 1. Department of Nephrology and Organ Transplantation, CHU Rangueil, Toulouse, France. 2. Department of Obstetrics, Paule de Viguier Hospital, Toulouse, France. 3. Molecular Immunogenetics Laboratory, EA 3034, Faculté de Médecine Purpan, IFR150 (INSERM), Toulouse, France Department of Immunology, CHU de Toulouse-Rangueil, Toulouse, France Université Paul Sabatier, Toulouse, France. 4. Department of Nephrology and Organ Transplantation, CHU Rangueil, Toulouse, France Université Paul Sabatier, Toulouse, France. 5. Department of Urology and Kidney Transplantation, CHU Rangueil, Toulouse, France. 6. Université Paul Sabatier, Toulouse, France Department of Urology and Kidney Transplantation, CHU Rangueil, Toulouse, France. 7. Department of Obstetrics, Paule de Viguier Hospital, Toulouse, France Université Paul Sabatier, Toulouse, France. 8. Department of Nephrology and Organ Transplantation, CHU Rangueil, Toulouse, France Université Paul Sabatier, Toulouse, France INSERM U1043, IFR-BMT, CHU Purpan, Toulouse, France.
Abstract
BACKGROUND: Kidney transplantation increases the chances for pregnancy and live birth for women with end-stage kidney disease. The aims of this study were to describe the outcomes of pregnancies in women with a kidney transplant and to evaluate the impact on anti-human leucocyte antigen (HLA) alloimmunization. METHODS: We analysed 61 pregnancies that occurred in 46 patients after having excluded 10 miscarriages during the first trimester and 10 other pregnancies from which important data were missing. Anti-HLA antibodies were screened using the Luminex assay. RESULTS: Overall, the live birth rate was 83% (94% after exclusion of miscarriages during the first trimester). Pre-eclampsia and gestational diabetes occurred in 26 and 21% of cases, respectively. The use of tacrolimus was an independent predictive factor for gestational diabetes. Twenty-four newborns (42%) were premature (<37 weeks). The median birth weight was 2720 (1040-3730) g. Nine newborns (15%) had low birth weights (<2.5 kg). At least one severe complication occurred in 56% of pregnancies. A high glomerular-filtration rate (GFR) before pregnancy was the sole independent protective factor that avoided a severe complication. Death-censored kidney-allograft survival was 80.4% at 6 years. De novo donor-specific anti-HLA antibodies were detected after only 5.9% of pregnancies: for two women, the father had the same HLA antigens as those from the deceased organ donor. The determination of the HLA of the father before pregnancy can better inform the woman about the possible impact of pregnancy on her kidney-allograft function. CONCLUSIONS: Despite many complications, the outcomes for pregnancy and kidney allografts are good. The risk of anti-HLA alloimmunization was low.
BACKGROUND: Kidney transplantation increases the chances for pregnancy and live birth for women with end-stage kidney disease. The aims of this study were to describe the outcomes of pregnancies in women with a kidney transplant and to evaluate the impact on anti-human leucocyte antigen (HLA) alloimmunization. METHODS: We analysed 61 pregnancies that occurred in 46 patients after having excluded 10 miscarriages during the first trimester and 10 other pregnancies from which important data were missing. Anti-HLA antibodies were screened using the Luminex assay. RESULTS: Overall, the live birth rate was 83% (94% after exclusion of miscarriages during the first trimester). Pre-eclampsia and gestational diabetes occurred in 26 and 21% of cases, respectively. The use of tacrolimus was an independent predictive factor for gestational diabetes. Twenty-four newborns (42%) were premature (<37 weeks). The median birth weight was 2720 (1040-3730) g. Nine newborns (15%) had low birth weights (<2.5 kg). At least one severe complication occurred in 56% of pregnancies. A high glomerular-filtration rate (GFR) before pregnancy was the sole independent protective factor that avoided a severe complication. Death-censored kidney-allograft survival was 80.4% at 6 years. De novo donor-specific anti-HLA antibodies were detected after only 5.9% of pregnancies: for two women, the father had the same HLA antigens as those from the deceased organ donor. The determination of the HLA of the father before pregnancy can better inform the woman about the possible impact of pregnancy on her kidney-allograft function. CONCLUSIONS: Despite many complications, the outcomes for pregnancy and kidney allografts are good. The risk of anti-HLA alloimmunization was low.
Authors: Anke Schwarz; Roland Schmitt; Gunilla Einecke; Frieder Keller; Ulrike Bode; Hermann Haller; Hans Heinrich Guenter Journal: BMC Nephrol Date: 2022-01-12 Impact factor: 2.388
Authors: Marleen C van Buren; Anouk Schellekens; T Katrien J Groenhof; Franka van Reekum; Jacqueline van de Wetering; Nina D Paauw; A Titia Lely Journal: Transplantation Date: 2020-08 Impact factor: 5.385