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Kidney Week

Abstract: TH-PO741

Successful Pregnancies In Kidney Transplant Recipients with Complement-Mediated Thrombotic Microangiopathy

Session Information

Category: Women’s Health and Kidney Diseases

  • 2000 Women’s Health and Kidney Diseases

Authors

  • Haninger-Vacariu, Natalja, Medical University of Vienna, Vienna, Austria
  • Gaggl, Martina M., Medical University of Vienna, Vienna, Austria
  • Aigner, Christof, Medical University of Vienna, Vienna, Austria
  • Prohaszka, Zoltan, Semmelweis Universtiy, Budapest, Hungary
  • Kain, Renate, Medical University of Vienna, Vienna, Austria
  • Bohmig, Georg, Medical University of Vienna, Vienna, Austria
  • Sunder-Plassmann, Raute, Medical University of Vienna, Vienna, Austria
  • Sunder-Plassmann, Gere, Medical University of Vienna, Vienna, Austria
  • Schmidt, Alice, Medical University of Vienna, Vienna, Austria
Background

Pregnancies in patients with complement gene variant mediated thrombotic microangiopathy (cTMA) are challenging, and pregnancies in such patients after kidney transplantation (KTX) even more so.

Methods

We identified pregnancies of patients enrolled in the Vienna TMA cohort and report maternal demographics and pregnancy as well as delivery outcomes of eight pregnancies after KTX in three genetically high-risk cTMA patients (Case 1: CFH, CFI, CFHR1, CFHR3, and CD46 variants. Case 2 & 3: CFH and CD46 variants).

Results

The three women were 21±2 years of age at cTMA manifestation, 25±1 years of age at KTX, and 32±2 years of age at their latest deliveries. Preventive plasma therapy was used in three pregnancies, and one patient had ongoing eculizumab (ECU) therapy during two pregnancies. Six out of eight pregnancies (75%) resulted in the delivery of healthy children, all of them appropriate for gestational age (delivery at gestational week 38±1.5; one preterm, case 1/pregnancy 4; two caesarean sections; four vaginal deliveries). The mean birth weight was 3305±317g, the mean birth length was 50±1cm, and the mean head circumference was 34±1cm. In addition, one pregnancy is still ongoing at gestational week 28+5 (case 3/pregnancy 5). The other two included one early abortion (case 3/pregnancy 1 at gestational week 12 during ongoing ECU therapy) and one late fetal death (case 1/pregnancy 3 at gestational week 33+3), most likely not related to complement dysregulation. Kidney transplant function after delivery remained stable in all but one pregnancy (case 2/pregnancy 3). In this latter case, a severe cTMA flare occurred after delivery despite use of preventive plasma infusions. Kidney graft function could be rescued in this patient by terminal complement blockade.

Conclusion

Successful pregnancies can be accomplished in kidney transplant recipients with a history of cTMA. We used preemptive plasma therapy or ongoing ECU treatment in selected cases. Thus, becoming pregnant can be encouraged in kidney transplant recipients with native kidney cTMA. Extensive preconception counseling, however, is mandatory in such cases.