title: [Husband to wife kidney transplantation in five multiparous women: sensitization or tolerance after pregnancy?].
abstract: BACKGROUND
  Pregnancy is a known cause of immunological sensitization and it has been reported graft survival to be lower in husband to wife kidney transplantation if the wife had been pregnant (mutual children) as compare to those cases without pregnancies. Previous exposure to husband HLA antigens during pregnancies may lead to specific sensitization to subsequent allografts.
  
  
  OBJECTIVE
  To communicate the fate of kidney allograft in husband to wife transplantation when the recipient had been pregnant.
  
  
  METHODS
  From 682 renal transplants performed at INCMNSZ 5 corresponded to husband to wife transplants. All the recipients were multiparous and had received multiple blood transfusions. Pretransplantation lymphocytotoxic cross-match testing were performed by complement dependent citotoxicity with antihuman globulin added (AHG-CDC), being negative in all cases for T and B cells. All the patients received triple-drug immunosuppressive therapy, additionally, anti-IL2R monoclonal antibodies were used in two cases.
  
  
  RESULTS
  Two patients developed: accelerated acute rejection (case 1), and acute humoral rejection (case 5), respectively. Graft in these patients were loss to rejection and transplant nephrectomy accomplished. The remaining three patients (cases 2, 3, and 4) has not had any rejection episode, and have had excellent graft outcome at 34, 30, and 21 months posttransplant, respectively.
  
  
  CONCLUSIONS
  Why under similar conditions some husband to wife kidney transplant recipients developed an adverse humoral immunological events while others maintain excellent long-term graft outcome? Is it possible to speculate that for some women pregnancy is in fact a sensitizing event, while in others it promotes "immunological acceptance"? At present there is no a test that characterized one and other group. Even though pretransplantation cross-match testing by flow cytometry is more sensitive than AHG-CDC, its negative result is by no means an absolute guarantee that an adverse anamnestic immunological event will not occur.
authors.affiliation: Departamento de Trasplantes, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México.
authors.forename: Víctor M
authors.initials: VM
authors.lastname: Ortiz-Arroyo
authors.forename: Julio
authors.initials: J
authors.lastname: Granados
authors.forename: Norma
authors.initials: N
authors.lastname: Uribe-Uribe
authors.forename: Claudia
authors.initials: C
authors.lastname: de Leo
authors.forename: Natalia
authors.initials: N
authors.lastname: Castelán
authors.forename: Norma
authors.initials: N
authors.lastname: González
authors.forename: Mayra
authors.initials: M
authors.lastname: López
authors.forename: Josefina
authors.initials: J
authors.lastname: Alberú
mesh_terms: D000328:Adult; D005190:Family; D005260:Female; D006801:Humans; D016030:Kidney Transplantation / Q000276:immunology*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D010298:Parity / Q000276:immunology*; D011247:Pregnancy / Q000276:immunology; D018454:Spouses