Antibody‐mediated rejection due to anti‐HLA‐DQ antibody after pregnancy and delivery in a female kidney transplant recipient

Sagasaki, Makoto; Nakada, Yasuyuki; Yamamoto, Izumi; Kawabe, Mayuko; Yamakawa, Takafumi; Katsumata, Haruki; Mafune, Aki; Katsuma, Ai; Kobayashi, Adam; Koike, Kentaro; Koike, Yusuke; Miki, Jun; Yamada, Hiroki; Kimura, Takahiro; Tanno, Yudo; Ohkido, Ichiro; Tsuboi, Nobuyuki; Yamamoto, Hiroyasu; Yokoo, Takashi

doi:10.1111/nep.13279

Cited by 4 publications

(4 citation statements)

References 16 publications

(17 reference statements)

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“…These include preeclampsia, hemolysis, elevated liver enzymes, low platelet count (HELLP) syndrome, acute fatty liver of pregnancy, thrombotic microangiopathies like thrombotic thrombocytopenic purpura and atypical hemolytic uremic syndrome, renal vein thrombosis, and urinary tract infection. Immunologic changes during pregnancy with fluctuating levels of immunosuppressive medications can lead to the development of de novo donor‐ specific antibody post‐pregnancy leading to antibody mediated rejection 22 . However, the actual incidence of de novo donor‐specific antibody in kidney transplant recipients during pregnancy is unknown and needs future investigation.…”

Section: Causes Of Pregnancy‐related Acute Kidney Injury In the Kidne...mentioning

confidence: 99%

“…Immunologic changes during pregnancy with fluctuating levels of immunosuppressive medications can lead to the development of de novo donor‐ specific antibody post‐pregnancy leading to antibody mediated rejection. 22 However, the actual incidence of de novo donor‐specific antibody in kidney transplant recipients during pregnancy is unknown and needs future investigation. Timely diagnosis and management of these can help prevent the progression of CKD in transplant allograft as well as improve maternal and fetal outcomes.…”

Section: Causes Of Pregnancy‐related Acute Kidney Injury In the Kidne...mentioning

confidence: 99%

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Acute kidney injury during pregnancy in kidney transplant recipients

Yadav

Salas

Coscia³

et al. 2022

Clinical Transplantation

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Pregnancy‐related acute kidney injury (AKI) is a public health problem and remains an important cause of maternal and fetal morbidity and mortality. The incidence of pregnancy‐related AKI has increased in developed countries due to increase in maternal age and higher detection rates. Pregnancy in women with kidney transplants is associated with higher adverse outcomes like preeclampsia, preterm births, and allograft dysfunction, but limited data exists on causes and outcomes of pregnancy‐related AKI in the kidney transplant population. Diagnosis of AKI during pregnancy remains challenging in kidney transplant recipients due to lack of diagnostic criteria. Management of pregnancy‐related AKI in the kidney transplant population requires a multidisciplinary team consisting of transplant nephrologists, high‐risk obstetricians, and neonatologists. In this review, we discuss pregnancy‐related AKI in women with kidney transplants, etiologies, pregnancy outcomes, and management strategies.

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Section: Causes Of Pregnancy‐related Acute Kidney Injury In the Kidne...mentioning

confidence: 99%

Section: Causes Of Pregnancy‐related Acute Kidney Injury In the Kidne...mentioning

confidence: 99%

Acute kidney injury during pregnancy in kidney transplant recipients

Yadav

Salas

Coscia³

et al. 2022

Clinical Transplantation

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“…10 Nevertheless, anecdotal case reports of acute rejection following pregnancy have been reported, with donor specific antibody emergence, especially when fetus/paternal HLA typing is similar to that of the donor. 41 Currently, there is no evidence to support increasing immunosuppression postpartum, but close surveillance in patients with donor/ father shared HLA typing could be helpful in identifying patients at risk of rejection.…”

Section: Woman With Renal Transplantmentioning

confidence: 99%

Untitled

2020

pjnh

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AND OPTIMIZATIONPrepregnancy counselling can be quite challenging due to the scarcity of solid evidence on how to advise women with CKD of diverse etiology. Pregnancy in women with advanced CKD, stages 3 to 5, is even more delicate as fertility is decreased, the occurrence of pregnancy reduced and data on pregnancy outcomes very limited.Women are referred by nephrologists, obstetricians and general practitioners. Counselling is made by an obstetrician and a nephrologist experienced in the management of pregnancies complicated by CKD. In complex cases, counselling is given at the same time, as a discussion concerning the possibility of anticipating renal replacement therapy is often necessary. Women's partners are invited to attend to participate in the shared decision process.Individualized advice is given based on the available recent scientific evidence, mainly focusing on fertility and its decrease as CKD progresses, the impact of pregnancy on kidney function, and maternal and fetal complications associated with CKD.In cases of hereditary nephropathy, patients are additionally counselled by a clinical geneticist on the risk of transmission to the offspring ABSTRACT Chronic kidney disease (CKD) is increasing worldwide and studies estimate that around 6% of women of childbearing age suffer from kidney disease. Preconception counselling of women with CKD and their management during pregnancy requires a multidisciplinary team, with both nephrologists and obstetricians experienced in advising and taking care of women across the CKD spectrum, including dialysis patients and women with a kidney transplant.Here, the authors describe a model of a Nephro-Obstetric outpatient clinic, created in 2011, detailing their current clinical experience in the management of this complex population of women.

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“…Az ABMR kialakulásának alapja az alloantitestek megjelenése. Az alloantitest kialakulásának legfőbb okai a terhesség [47], az ismételt transzfúziók és a korábbi transzplantációk, melyek során a szervezet a számára idegen HLA antigénnel találkozik. A várólistán lévő betegek körülbelül 10-30%-a tekinthető immunizáltnak, esetükben a keringő HLA-ellenes antitest 5-20% feletti; az immunizáltság küszöbértéke eltér az egyes transzplantációs programok között.…”

Section: Az Abmr Rizikófaktoraiunclassified

Antitestmediált rejekció: kihívás a veseátültetett betegek kezelésében

et al. 2018

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Antibody-mediated rejection (ABMR) is one of the factors affecting the long-term graft survival after kidney transplantation (KT). Two kidney transplant centres (University of Debrecen and University of Pécs) followed up their data of cadaveric KTs that had been performed between 2013 and 2017, and reviewed the literature. There were 454 KTs in the mentioned period, 18 cases (4%) were recognised as ABMRs. Biopsy has been performed in all cases. 22% were primary, and 78% retransplanted patients. The average age was 51.2 ± 6 years. ABMR occurred 15.4 ± 22.1 months after KT. Histology showed C4d positivity in 39% of the cases. The treatment was steroid bolus + intravenous immunoglobulin (IVIG) + plasma exchange (PE) in 16 cases, rituximab was additionally given in 5 cases. 47.4% of the patients are alive with a functioning graft, four (21%) died, and 31% of the patients had a graft loss due to ABMR. ABMR is a dangerous complication after KT. Diagnostic criteria has been unclear for years. Gold standard is the histology, however, accelerated ABMR may occur even in C4d negative cases. The exposed group includes young, retransplanted patients, having a preformed donor-specific antibody (DSA), and receiving a graft from an EC donor. The occurrence of de novo DSA and the kinetics of mean fluorescence intensity (MFI) of existing ones can be a signal for the risk of an ABMR. The effectiveness of rituximab is not proven, there is a lack of long-term controlled trials for new drugs. Our results of over 40% recovery is an extensively good result. Orv Hetil. 2018; 159(46): 1913–1929.

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Antibody‐mediated rejection due to anti‐HLA‐DQ antibody after pregnancy and delivery in a female kidney transplant recipient

Cited by 4 publications

References 16 publications

Acute kidney injury during pregnancy in kidney transplant recipients

Acute kidney injury during pregnancy in kidney transplant recipients

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Antitestmediált rejekció: kihívás a veseátültetett betegek kezelésében

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