Kidney transplant recipients are at an increased risk for pregnancy-associated complications including preeclampsia (PEC). Endothelial injury in the placenta is a hallmark of PEC. The presence of anti-HLA donor specific antibodies (DSA) is associated with endothelial injury to the allograft. We aimed to assess whether patients with DSA before or during pregnancy had inferior outcomes when compared to those without DSA.

A retrospective chart review of all pregnant kidney transplant recipients from 2007 to 2017 was performed. Patients were classified as either DSA positive (MFI >1000) before and/or during pregnancy (n=8) or DSA negative (n=10). Outcomes between DSA positive and DSA negative patients were compared (Table 1).

When compared to patients without DSA, patients with DSA were more likely to have a flow positive cross match (P=0.07) and receive triple drug immunosuppressive therapy (P=0.05). Patients with DSA were significantly more likely to have a diagnosis of PEC and/or accelerated hypertension with proteinuria at the time of delivery (P=0.01). Gestational age at delivery and birth weights were lower in the DSA positive group (P=0.10). Serum creatinine significantly increased throughout the course of pregnancy in the DSA positive group only, P=0.05 (Figure 1). In the DSA group, 2 patients received a spousal transplant. HLA typing from the partners of 2 additional DSA positive patients indicated shared antigens between the husband and the donor. There was no difference in graft survival between the groups.

Our study indicates that DSA before or during pregnancy may be a risk factor for adverse pregnancy outcomes including PEC. Larger studies are warranted to better determine the effects and mechanisms of pre-sensitization on pregnancy outcomes.

CITATION INFORMATION: Lubetzky M., Muthukumar T., Lee J., Lee J., Hartono C., Mahla L., Serur D., Dadhania D. Donor Specific Antibodies Increase the Risk of Preeclampsia in Pregnant Kidney Transplant Recipients Am J Transplant. 2017;17 (suppl 3).

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