Belatacept during pregnancy in renal transplant recipients: Two case reports

Combs, Jenna; Kagan, Anna; Boelkins, Mark; Coscia, Lisa A.; Moritz, Michael J.; Hofmann, Robert

doi:10.1111/ajt.14911

Cited by 21 publications

(18 citation statements)

References 6 publications

(12 reference statements)

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“…The literature is rich with reports on extreme situations, including kidney transplantation during pregnancy; while single cases cannot lead to potentially risky changes in daily practices, such cases do warn against fully negative attitudes and suggest an individually based decision [ 145 , 146 , 147 , 148 , 149 , 150 , 151 ].…”

Section: Kidney Transplantationmentioning

confidence: 99%

Pregnancy in Chronic Kidney Disease: Need for Higher Awareness. A Pragmatic Review Focused on What Could Be Improved in the Different CKD Stages and Phases

Piccoli

Zakharova

Attini

et al. 2018

JCM

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Pregnancy is possible in all phases of chronic kidney disease (CKD), but its management may be difficult and the outcomes are not the same as in the overall population. The prevalence of CKD in pregnancy is estimated at about 3%, as high as that of pre-eclampsia (PE), a better-acknowledged risk for adverse pregnancy outcomes. When CKD is known, pregnancy should be considered as high risk and followed accordingly; furthermore, since CKD is often asymptomatic, pregnant women should be screened for the presence of CKD, allowing better management of pregnancy, and timely treatment after pregnancy. The differential diagnosis between CKD and PE is sometimes difficult, but making it may be important for pregnancy management. Pregnancy is possible, even if at high risk for complications, including preterm delivery and intrauterine growth restriction, superimposed PE, and pregnancy-induced hypertension. Results in all phases are strictly dependent upon the socio-sanitary system and the availability of renal and obstetric care and, especially for preterm children, of intensive care units. Women on dialysis should be aware of the possibility of conceiving and having a successful pregnancy, and intensive dialysis (up to daily, long-hours dialysis) is the clinical choice allowing the best results. Such a choice may, however, need adaptation where access to dialysis is limited or distances are prohibitive. After kidney transplantation, pregnancies should be followed up with great attention, to minimize the risks for mother, child, and for the graft. A research agenda supporting international comparisons is highly needed to ameliorate or provide knowledge on specific kidney diseases and to develop context-adapted treatment strategies to improve pregnancy outcomes in CKD women.

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Section: Kidney Transplantationmentioning

confidence: 99%

Pregnancy in Chronic Kidney Disease: Need for Higher Awareness. A Pragmatic Review Focused on What Could Be Improved in the Different CKD Stages and Phases

Piccoli

Zakharova

Attini

et al. 2018

JCM

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“…This case supports the 2 previously reported pregnancies in kidney transplant recipients on belatacept. (4) What stands out is that our patient, who was treated with belatacept and minimal standard immunosuppression, did not experience any of the frequent and serious complications described by previous authors (1,2) and in the Transplant Pregnancy Registry. (3) We did not lower or discontinue her already minimal standard immunosuppression, leaving her on belatacept alone, because she had developed cAMR in 2 liver grafts that was controlled by adding belatacept.…”

Section: Discussionmentioning

confidence: 51%

Successful Pregnancy in a Liver Transplant Recipient on Belatacept

Klintmalm

Gunby

2020

Liver Transpl

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“…Information regarding the safety of immunosuppressant drugs in pregnancy accumulates slowly and is hampered by the absence of comprehensive post marketing ascertainment of pregnancy outcomes in women treated with immunosuppressant medications. For example, belatacept is available but its association and safety with pregnancy is known only from case reports [24]. Infertility due to chronic illness and patients choosing to use effective birth control options could be other contributing factors to lower rates of pregnancy in kidney transplant recipients as compared to general population.…”

Section: Discussionmentioning

confidence: 99%

Racial disparities and factors associated with pregnancy in kidney transplant recipients in the United States

et al. 2019

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Background Although kidney transplant improves reproductive function in women with end-stage kidney disease (ESKD), pregnancy in kidney transplant recipients’ remains challenging due to the risk of adverse maternal and fetal outcomes. Methods We evaluated a retrospective cohort of 7,966 women who were aged 15–45 years and received a kidney transplant between January 1, 2005 and December 31, 2011 from the United States Renal Data System with Medicare as the primary payer for the entire three years after the date of transplantation. Unadjusted and adjusted rates of pregnancy in the first three post-transplant years were calculated, using Poisson regression for the adjustment. Factors associated with pregnancy, including race, were examined using logistic regression. Results Overall, 293 pregnancies were identified in 7966 women. The unadjusted pregnancy rate was 13.8 per thousand person-years (PTPY) (95% confidence interval (CI), 12.3–15.5). Pregnancy rates were roughly constant in the years 2005–2011 except in 2005 and 2010. The rate of pregnancy was highest in Hispanic women (21.4 PTPY; 95% CI, 17.2–26.4) and Hispanic women had a higher likelihood of pregnancy as compared to white women (OR, 1.56; CI, 1.12–2.16). Pregnancy rates were lowest in women aged 30–34 years and 35–45 years at transplant, and women aged 30–34 years and 35–45 years at transplant were less likely to ever become pregnant during the follow-up (odds ratio [OR], 0.69; CI, 0.49–0.98 and OR, 0.14; CI 0.09–0.21 respectively) as compared to women aged 25–29 years at time of transplant. Women had higher rates of pregnancy in the second and third-year post-transplant (16.0 PTPY, CI 13.2–19.2 and 16.9 PTPY, CI 14.0–20.4) than in the first-year post-transplant (9.0 PTPY, CI 7.0–11.4). In transplant recipients, pregnancy was more likely in women with ESKD due to cystic disease (OR, 2.42; CI, 1.02–5.74) or glomerulonephritis (OR, 2.14; CI, 1.07–4.31) as compared to women with ESKD due to diabetes. Conclusion Hispanic race, younger age, and ESKD cause due to cystic disease or glomerulonephritis are significant factors associated with a higher likelihood of pregnancy. Pregnancy rates have been fairly constant over the last decade. This study improves our understanding of factors associated with pregnancy in kidney transplant recipients.

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Belatacept during pregnancy in renal transplant recipients: Two case reports

Cited by 21 publications

References 6 publications

Pregnancy in Chronic Kidney Disease: Need for Higher Awareness. A Pragmatic Review Focused on What Could Be Improved in the Different CKD Stages and Phases

Pregnancy in Chronic Kidney Disease: Need for Higher Awareness. A Pragmatic Review Focused on What Could Be Improved in the Different CKD Stages and Phases

Successful Pregnancy in a Liver Transplant Recipient on Belatacept

Racial disparities and factors associated with pregnancy in kidney transplant recipients in the United States

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