Date: Tuesday, May 5, 2015
Session Time: 5:30pm-6:30pm
Presentation Time: 5:30pm-6:30pm
Location: Exhibit Hall E
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.
To cite this abstract in AMA style:Ajaimy M, Lubetzky M, Kamal L, Bocardo GDe, Akalin E. Pregnancy After Renal Transplantation: Unfavorable Outcomes in Sensitized Patients [abstract]. Am J Transplant. 2015; 15 (suppl 3). https://atcmeetingabstracts.com/abstract/pregnancy-after-renal-transplantation-unfavorable-outcomes-in-sensitized-patients/. Accessed January 17, 2020.
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