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Abstract: SA-OR117

Maternal Pregnancy Outcomes in Women with Complement-Mediated TMA: Update of the Vienna TMA Cohort

Session Information

Category: Women’s Health and Kidney Diseases

  • 2000 Women’s Health and Kidney Diseases

Authors

  • Gaggl, Martina M., Medical Universitiy of Vienna, Vienna, Austria
  • Haninger-Vacariu, Natalja, Medical Universitiy of Vienna, Vienna, Austria
  • Aigner, Christof, Medical Universitiy of Vienna, Vienna, Austria
  • Sunder-Plassmann, Gere, Medical Universitiy of Vienna, Vienna, Austria
  • Schmidt, Alice, Medical Universitiy of Vienna, Vienna, Austria
Background

Pregnancy is a high-risk scenario to trigger complement pathway dysregulation. Presentation of paternal antigens activates the maternal alternative pathway and in women with malfunctioning complement regulatory proteins or C3 life-threatening thrombotic microangiopathy (TMA) can develop.

Methods

As of 2015 we reported outcomes of 27 pregnancies in 14 women with complement-mediated TMA (cTMA) enrolled in the Vienna TMA cohort (VTC). This work presents an update on this open cohort as of May 2019: Outcomes are CKD stage at last follow-up, incidence of dialysis or kidney transplantation (KTX) and death.

Results

In 32 women of the VTC the mean age at first cTMA presentation was 30 ±16 years (figure 1). Up until 2019 in 25 women a total of 55 pregnancies were observed: 6 women 1, 9 women 2, 6 women 3, 2 women 4, 1 woman 5 pregnancies. In 14 women pregnancy occurred before diagnosis of cTMA (26 pregnancies, 6 abortions) with 8 pregnancies afterwards in 5 women. Pregnancy-associated cTMA (p-cTMA) happened in 11 women: 6 during first, 3 during second and 2 during a later pregnancy. Five women had 11 pregnancies following KTX.
Thirty-nine (71%) pregnancies were untreated and not complicated by p-cTMA. Four women received preventive plasma therapy for 6 pregnancies (2 KTX; 1 p-cTMA), 2 became pregnant during ongoing eculizumab therapy (3 pregnancies,1 KTX; 0 p-cTMA), 5 received therapeutic plasma therapy for p-cTMA (1 KTX), and 2 were switched to eculizumab (0 ESRD). At last follow-up 20 had eGFR ≥60ml/min per 1.73m2, 6 eGFR <60, 2 needed dialysis and 4 had died.

Conclusion

In summary, VTC data demonstrates good maternal outcome (1) in the majority of untreated pregnancies in women with a diagnosis of cTMA and (2) in specifically treated cTMA patients in a specialized center.

Figure 1.