Background: The objective of our study was to describe pregnancy and allograft outcomes in sensitized kidney recipients in a predominantly Hispanic and African-American population.

Methods: This is a single-center retrospective cohort study of adult kidney transplant recipients who became pregnant from June 1, 2009 through December 31, 2012. Anti-HLA antibodies were studied by Luminex Single Antigen Bead assays.

Results: There were 9 pregnant patients with a median age of 36 years (22, 38), 4 were Hispanic and 3 African-American. This was the first kidney transplant for all 9 women, 6 from living and 3 from deceased donors. Pregnancies occurred at a median of 3.1 years (1.1, 7.2) after transplantation. Pre-pregnancy median serum creatinine levels and spot urine protein/creatinine ratio (UPC) were 1.1 mg/dl (1.1, 2.1), and 0.55 g/day (0, 1.2) respectively. Three patients had a panel reactive antibody (PRA) of 0% at the time of conception and the remaining 6 patients were sensitized with a median class I PRA level of 46% (25, 98) and class II of 0% (0, 86). While the non-sensitized 3 patients had uneventful pregnancy and delivered babies at a median of 37 weeks of gestation (36, 38) and the median weight of the babies was 2586 grams (1542, 2948), the sensitized 6 patients had a higher incidence of adverse pregnancy outcomes; 1 stillbirth, 1 late miscarriage and 3 developed pre-eclampsia. Babies of sensitized females were born at a median of 30 weeks of gestation (23, 37) and the median weight of the babies was 519 grams (400, 2732). During a median follow-up of 2.3 years (2, 4) after delivery, 6 of the 9 patients had a relatively stable kidney function with a median serum creatinine of 1.6 mg/dl (1.1, 2.2) and a median UPC of 0.45 g/day (0.4, 0.75). The other 3 patients, all with high PRA levels, developed antibody-mediated rejection (AMR) within a year after delivery. All 3 patients with AMR were found to have de novo donor-specific anti-HLA antibodies (DSA) with C1q activities and suffered graft loss despite the treatment of AMR.

Conclusions: Our study suggests that sensitized kidney transplant females are at increased risk of adverse pregnancy outcomes including pre-term delivery, preeclampsia, and low birth weight infants. We also found an increased risk of AMR, developing new DSA with C1q activity and graft loss after delivery.

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