title: Pregnancy after kidney transplantation: outcome and anti-human leucocyte antigen alloimmunization risk.
abstract: BACKGROUND
  Kidney transplantation increases the chances for pregnancy and live birth for women with end-stage kidney disease. The aims of this study were to describe the outcomes of pregnancies in women with a kidney transplant and to evaluate the impact on anti-human leucocyte antigen (HLA) alloimmunization.
  
  
  METHODS
  We analysed 61 pregnancies that occurred in 46 patients after having excluded 10 miscarriages during the first trimester and 10 other pregnancies from which important data were missing. Anti-HLA antibodies were screened using the Luminex assay.
  
  
  RESULTS
  Overall, the live birth rate was 83% (94% after exclusion of miscarriages during the first trimester). Pre-eclampsia and gestational diabetes occurred in 26 and 21% of cases, respectively. The use of tacrolimus was an independent predictive factor for gestational diabetes. Twenty-four newborns (42%) were premature (<37 weeks). The median birth weight was 2720 (1040-3730) g. Nine newborns (15%) had low birth weights (<2.5 kg). At least one severe complication occurred in 56% of pregnancies. A high glomerular-filtration rate (GFR) before pregnancy was the sole independent protective factor that avoided a severe complication. Death-censored kidney-allograft survival was 80.4% at 6 years. De novo donor-specific anti-HLA antibodies were detected after only 5.9% of pregnancies: for two women, the father had the same HLA antigens as those from the deceased organ donor. The determination of the HLA of the father before pregnancy can better inform the woman about the possible impact of pregnancy on her kidney-allograft function.
  
  
  CONCLUSIONS
  Despite many complications, the outcomes for pregnancy and kidney allografts are good. The risk of anti-HLA alloimmunization was low.
authors.affiliation: Department of Nephrology and Organ Transplantation, CHU Rangueil, Toulouse, France.
authors.forename: Anne Laure
authors.initials: AL
authors.lastname: Hebral
authors.affiliation: Department of Nephrology and Organ Transplantation, CHU Rangueil, Toulouse, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Cointault
authors.affiliation: Department of Obstetrics, Paule de Viguier Hospital, Toulouse, France.
authors.forename: Laure
authors.initials: L
authors.lastname: Connan
authors.affiliation: Molecular Immunogenetics Laboratory, EA 3034, Faculté de Médecine Purpan, IFR150 (INSERM), Toulouse, France Department of Immunology, CHU de Toulouse-Rangueil, Toulouse, France Université Paul Sabatier, Toulouse, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Congy-Jolivet
authors.affiliation: Department of Nephrology and Organ Transplantation, CHU Rangueil, Toulouse, France.
authors.forename: Laure
authors.initials: L
authors.lastname: Esposito
authors.affiliation: Department of Nephrology and Organ Transplantation, CHU Rangueil, Toulouse, France.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Cardeau-Desangles
authors.affiliation: Department of Nephrology and Organ Transplantation, CHU Rangueil, Toulouse, France Université Paul Sabatier, Toulouse, France.
authors.forename: Arnaud
authors.initials: A
authors.lastname: Del Bello
authors.affiliation: Department of Nephrology and Organ Transplantation, CHU Rangueil, Toulouse, France.
authors.forename: Laurence
authors.initials: L
authors.lastname: Lavayssière
authors.affiliation: Department of Nephrology and Organ Transplantation, CHU Rangueil, Toulouse, France.
authors.forename: Marie Béatrice
authors.initials: MB
authors.lastname: Nogier
authors.affiliation: Department of Nephrology and Organ Transplantation, CHU Rangueil, Toulouse, France.
authors.forename: David
authors.initials: D
authors.lastname: Ribes
authors.affiliation: Department of Nephrology and Organ Transplantation, CHU Rangueil, Toulouse, France.
authors.forename: Joelle
authors.initials: J
authors.lastname: Guitard
authors.affiliation: Department of Urology and Kidney Transplantation, CHU Rangueil, Toulouse, France.
authors.forename: Federico
authors.initials: F
authors.lastname: Sallusto
authors.affiliation: Université Paul Sabatier, Toulouse, France Department of Urology and Kidney Transplantation, CHU Rangueil, Toulouse, France.
authors.forename: Xavier
authors.initials: X
authors.lastname: Gamé
authors.affiliation: Department of Obstetrics, Paule de Viguier Hospital, Toulouse, France Université Paul Sabatier, Toulouse, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Parant
authors.affiliation: Department of Obstetrics, Paule de Viguier Hospital, Toulouse, France.
authors.forename: Alain
authors.initials: A
authors.lastname: Berrebi
authors.affiliation: Department of Nephrology and Organ Transplantation, CHU Rangueil, Toulouse, France Université Paul Sabatier, Toulouse, France INSERM U1043, IFR-BMT, CHU Purpan, Toulouse, France.
authors.forename: Lionel
authors.initials: L
authors.lastname: Rostaing
authors.affiliation: Department of Nephrology and Organ Transplantation, CHU Rangueil, Toulouse, France Université Paul Sabatier, Toulouse, France INSERM U1043, IFR-BMT, CHU Purpan, Toulouse, France.
authors.forename: Nassim
authors.initials: N
authors.lastname: Kamar
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D060730:Glomerular Filtration Barrier; D006084:Graft Rejection / Q000276:immunology; D006085:Graft Survival / Q000276:immunology; D006680:HLA Antigens / Q000276:immunology; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007231:Infant, Newborn; D007676:Kidney Failure, Chronic / Q000276:immunology; D016030:Kidney Transplantation; D008875:Middle Aged; D011225:Pre-Eclampsia / Q000453:epidemiology / Q000276:immunology; D011247:Pregnancy; D011248:Pregnancy Complications / Q000276:immunology / Q000601:surgery*; D011256:Pregnancy Outcome; D016559:Tacrolimus / Q000627:therapeutic use; D014184:Transplantation, Homologous; D055815:Young Adult
chemical_list: D006680:HLA Antigens; D007166:Immunosuppressive Agents; D016559:Tacrolimus
keywords: DSA; kidney function; kidney transplantation; live birth; pregnancy