Abstract: TH-PO952

Effect of Pregnancy Post-Transplant on Rejection and HLA-DSA Development

Session Information

Category: Transplantation

  • 1702 Transplantation: Clinical and Translational

Authors

  • Khoury, Nadeen J., Mayo Clinic, Rochester, Minnesota, United States
  • Kattah, Andrea G., Mayo Clinic, Rochester, Minnesota, United States
  • Cosio, Fernando G., Mayo Clinic, Rochester, Minnesota, United States
Background

Pregnancy is known to be a sensitizing event; however, most studies have suggested that allograft function is not impaired. We looked at our transplant cohort to assess for rejection post-pregnancy and development of de Novo donor specific antibodies (DSA).

Methods

We used our transplant database to identify the female patient population who were 16-46 years old at the time of transplant. We included transplants which occurred between 1996 to 2014. Patients with a functioning graft for at least 2 years post-transplant were included in our data analysis. We then used pregnancy codes to select those who had a pregnancy or pregnancy-related event.

Results

We identified 47 patients with pregnancy-specific codes from an initial cohort of 412 patients. After excluding patients who had pregnancies prior to transplant and multiorgan transplants, we were left with 11 patients with appropriate pathology and DSA data. These patients were all Caucasian and received living kidney transplants. Thymoglobulin and alemtuzumab were used for induction. Triple immunosuppression was used initially with mycophenolate mofetil switched to azathioprine prior to pregnancy. Age at the time of pregnancy was between 27 and 38 and primary kidney disease included: HTN nephrosclerosis, reflux disease, IgA and anti-GBM disease. Serum creatinine at the time of transplant was 0.9-2.1 with proteinuria ranging between 31 to 157 mg/24h. 8 had a single pregnancy post-transplant and 3 had two pregnancies. Post-pregnancy biopsies were performed at 2-12 months post delivery. None of the patients had evidence of acute rejection, 8 had mild to moderate arteriosclerosis and arteriolar hyalinosis and 3 had features of chronic antibody mediated rejection, including transplant arteriopathy and glomerulopathy. The women with chronic antibody mediated rejection all had de novo DSA and were the ones with 2 pregnancies.

Conclusion

Most pregnancies post-transplant carry a benign course; it does appear however, that multiple pregnancies might trigger de novo DSA and chronic antibody mediated rejection. It would be important to have larger studies to further delineate this phenomenon and help counsel women who desire to conceive after transplant.