title: Incidence and risk factors of anti-HLA immunization after pregnancy.
abstract: Pregnancy is the only natural source of anti-HLA immunization. The exact frequency of this immunization remains undetermined as prior studies either used methods with a low sensitivity or were performed late after delivery. We present here the first study on women at delivery evaluating anti-HLA immunization by Luminex. We also attempted to isolate factors influencing immunization, such as soluble HLA-G (sHLA-G) levels and genetic polymorphisms. With Luminex, anti-HLA immunization was observed in 54.4% of the women. As expected, immunization frequency increased with the number of children, reaching 74% in women with >2 deliveries. Among immunized women, strong cytotoxic Ab (as detected by Complement Dependent Cytotoxicity) were associated with a lower level of sHLA-G. None of the studied polymorphisms influenced immunization rate in the whole cohort. Among 94 first pregnant women with no history of miscarriage, the -174 IL-6 gene promoter mutation (G/C) appeared more frequently in non immunized women (69% vs. 45% in immunized ones, p=0.02). Lastly, the occurrence of a miscarriage before the first live delivery significantly decreased immunization. These results may help to understand mechanisms of pregnancy induced immunization. They also have an impact in the management of previous pregnant women requiring organ or hematopoietic stem cell transplantation.
authors.affiliation: UMR 1098, Inserm, Université de Franche-Comté, Etablissement Français du Sang BFC, IFR 133, Besançon, France. emeline.masson@sls.aphp.fr
authors.forename: Emeline
authors.initials: E
authors.lastname: Masson
authors.forename: Chrystelle
authors.initials: C
authors.lastname: Vidal
authors.forename: Marina
authors.initials: M
authors.lastname: Deschamps
authors.forename: Severine
authors.initials: S
authors.lastname: Bongain
authors.forename: Chantal
authors.initials: C
authors.lastname: Thevenin
authors.forename: Isabelle
authors.initials: I
authors.lastname: Dupont
authors.forename: Didier
authors.initials: D
authors.lastname: Rietmulher
authors.forename: Fabienne
authors.initials: F
authors.lastname: Pouthier
authors.forename: Gilbert
authors.initials: G
authors.lastname: Mongaillard
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Chabod
authors.forename: Christophe
authors.initials: C
authors.lastname: Ferrand
authors.forename: Pierre
authors.initials: P
authors.lastname: Tiberghien
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Rebibou
mesh_terms: D000328:Adult; D000906:Antibodies / Q000276:immunology*; D003602:Cytotoxicity, Immunologic; D005260:Female; D006680:HLA Antigens / Q000276:immunology*; D006801:Humans; D007114:Immunization; D007074:Immunoglobulin G / Q000097:blood / Q000276:immunology; D007075:Immunoglobulin M / Q000097:blood / Q000276:immunology; D015994:Incidence; D015850:Interleukin-6 / Q000235:genetics / Q000276:immunology; D011247:Pregnancy; D012307:Risk Factors
chemical_list: D000906:Antibodies; D006680:HLA Antigens; D007074:Immunoglobulin G; D007075:Immunoglobulin M; D015850:Interleukin-6
keywords: Ab; Ag; B cell Activating Factor; BAFF; C-reactive Protein; CDC; CRP; DTT; HLA; IL-6; TLR4; antibody; antigen; complement dependent cytotoxicity; dithiothreitol; human leukocyte antigen; interleukine 6; sHLA-G; soluble HLA-G; toll-like receptor 4