Pregnancy after kidney and kidney-pancreas transplantation under tacrolimus: a single center’s experience

Jain, Ashokkumar; Shapiro, Ron; Scantlebury, Velma P.; Potdar, Santosh; Jordan, Mark L.; Flohr, Jareen Adams; Marcos, Amadeo; Fung, John J.

doi:10.1097/01.tp.0000117564.50117.fb

Cited by 75 publications

(42 citation statements)

References 9 publications

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“…The concept is, however, further supported by the strong association between preeclampsia/ eclampsia (likely the most frequent presentation of a GVHD-like syndrome, with clear (auto)immune components) and PTD [3][4][5] and, ultimately, by the fact that women with solid organ transplantations, practically uniformly in all published case series, also demonstrate an abnormally high prevalence of PTD [98][99][100][101].…”

Section: Discussionmentioning

confidence: 91%

Does the Immune System Induce Labor? Lessons from Preterm Deliveries in Women with Autoimmune Diseases

Gleicher

2009

Clinic Rev Allerg Immunol

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A recent review of the literature suggested that thyroid autoimmunity is statistically associated with preterm delivery. This observation raises a number of follow-up questions, among them whether autoimmune function, in general, predisposes to premature delivery. A review of the English literature for the last 10 years, via PubMed search, finds strong supportive evidence for such a hypothesis. Since the fetal-placental unit represents a (semi) allograft within a maternal (allograft) recipient, it is reasonable to assume that it is subject to similar immunologic tolerance (and failure thereof) as solid organ transplants. As autoimmune responses represent a normal feature of tolerance failure in organ transplantation, similar autoimmune responses can also be expected with failure of tolerance of the fetal-maternal graft. The association of premature (and possibly also term) labor with autoimmune function may, therefore, be the consequence of abnormalities in normal fetal-placental tolerance, leading to uterine activation and labor.

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Section: Discussionmentioning

confidence: 91%

Does the Immune System Induce Labor? Lessons from Preterm Deliveries in Women with Autoimmune Diseases

Gleicher

2009

Clinic Rev Allerg Immunol

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“…25 Importantly it can be used after initial induction therapy as a single immunosuppressant in liver transplantation, 26 and tacrolimus has been used extensively during pregnancies in organ transplant recipients (a significant consideration for UTn). 27,28 The latest study on the effects of tacrolimus on UTn, evaluated the effects of tacrolimus on the rejection of a transplanted rat uterus and on uterine expression of markers of inflammation and implantation. 28 Nontreated uterine grafts showed rejection with necrosis.…”

Section: Discussionmentioning

confidence: 99%

Achieving an early pregnancy following allogeneic uterine transplantation in a rabbit model

Saso¹,

Petts²,

David³

et al. 2015

European Journal of Obstetrics & Gynecology and Reproductiv

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A Case of Pregnancy following Allogeneic Uterine Transplantation in a Rabbit ModelPopulation 18 New Zealand white allogeneic rabbit does of proven fertility were used as donor and recipient animals (nine donors, nine recipients). MethodsNine allogeneic UTn in the rabbit model were performed using a pre-determined protocol. Embryos were transferred into each cornua via a mini-midline laparotomy. The pregnancy was monitored with regular reproductive profiles and a colour Doppler ultrasound to measure fetal growth. Main Outcome MeasuresPresence of conceptus, size and growth of fetus, markers of acute rejection, biochemical reproductive, renal and hepatic profiles. ResultsRecipient #5 was the sole surviving doe out of the cohort of nine. Day 5 post-embryo transfer (D5) scan did not demonstrate a fetal sac. Fetal sac diameter on D9, D13, D16 and D18 was (mm): 17.3x13. 1, 22.1x19.5, 25.2x22.7, and 10.2x6.3. Crown-rump length was only recordable on D9, D13 and D16. Subsequent scans on D22 and D25 did not demonstrate a fetal sac, which together with the fetal sac diameter was suggestive of resorption. The recipient was sacrificed on D27.Necropsy and histopathology confirmed evidence of a gravid uterus and presence of a gestational sac.Conclusions Despite the end result of the experiment i.e. termination of pregnancy as a result of miscarriage, the study represents only the third example of conception and pregnancy following an allogeneic UTn. Key WordsFertility, Uterine Transplantation, Rabbit, Pregnancy Abstract Word Count 254Manucript Word Count 4414 4

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“…There were no maternal or fetal deaths, no rejection was observed during pregnancies and serum creatinine levels remained stable during and after pregnancy. The only negative evidence, compared to the normal population, was a higher incidence of spontaneous abortion (23.5 vs. 16%) [79] .…”

Section: Immunosuppression and Pregnancy In Kidney Transplant Recipientsmentioning

confidence: 99%

“…According to data reported in the National Transplantation Pregnancy Register, pregnant kidney transplant recipients who maintained stable function during their pregnancies took higher doses of cyclosporine before and during pregnancy than patients who had renal dysfunction [80] . Based on the use of tacrolimus, Jain et al [79] reported 21 pregnancies with decreased trough levels for kidney and kidney-pancreas recipients with no rejection episodes. Available reports indicate a similar rejection rate between the transplant recipient population with and without pregnancies [70,82] .…”

Section: Immunosuppression and Pregnancy In Kidney Transplant Recipientsmentioning

confidence: 99%

Update on Pregnancy in Chronic Kidney Disease

Castellano¹,

Losappio²,

Gesualdo³

2011

Kidney Blood Press Res

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The occurrence of pregnancy in patients with chronic kidney disease (CKD) has been considered a dangerous event both for the mother and for the fetus. However, increasing evidence shows that the stage of CKD is the leading factor that can predict possible acceleration in the declining of renal function and complications of pregnancy. This review summarizes recent data on pregnancy in patients with CKD, dialysis and kidney transplantation.

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Pregnancy after kidney and kidney-pancreas transplantation under tacrolimus: a single center’s experience

Cited by 75 publications

References 9 publications

Does the Immune System Induce Labor? Lessons from Preterm Deliveries in Women with Autoimmune Diseases

Does the Immune System Induce Labor? Lessons from Preterm Deliveries in Women with Autoimmune Diseases

Achieving an early pregnancy following allogeneic uterine transplantation in a rabbit model

Update on Pregnancy in Chronic Kidney Disease

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