title: Immunologic evaluation of the endometrium with a levonorgestrel intrauterine device in solid organ transplant women and healthy controls.
abstract: The objective was to describe the endometrial milieu of stable transplant patients and healthy women before and after levonorgestrel intrauterine system (LNG-IUS) insertion.
  
  
  
  Women between 18 and 45 years of age desiring LNG-IUS insertion were enrolled with a 2:1 ratio of healthy to stable solid organ transplant patients. The first visit entailed a blood draw, uterine lavage and endometrial biopsy followed by LNG-IUS insertion. Follow-up visit involved a repeat serum draw, uterine lavage and endometrial biopsy. Cytokine levels were measured in the uterine lavage and serum by quantifying inflammatory biomarkers. Immunohistochemistry staining was performed on the endometrial tissue to measure macrophage levels. Statistical analysis included a nonparametric analysis that compared medians of the marker levels before and after intrauterine device (IUD) insertion within the group and between the two groups.
  
  
  
  Sixteen participants completed the study: 5 solid organ transplant patients and 11 healthy patients. For the serum, there were no marked changes in the cytokines or soluble receptor levels in either group after IUD insertion. However, in the uterine lavage, there was an increase in cytokine levels post-IUD insertion for both healthy and transplant women. For the endometrial tissue, there was evidence of macrophage activity in both groups after device insertion.
  
  
  
  This pilot study investigated the uterine environment of the transplant patient population. Findings have pointed to the strong local inflammatory response following LNG-IUS insertion for the transplant recipients. In addition, these preliminary findings will help power a larger study that can investigate the safety and effectiveness of the IUD in this patient population.
  
  
  
  Findings from this pilot study suggest that the IUD is inducing a local inflammatory reaction in the uterus of the transplant patient as in the healthy control. A larger study can build on these preliminary results to pursue the efficacy and safety of IUD use among solid organ transplant patients.
authors.affiliation: University of California, Los Angeles, Department of Obstetrics and Gynecology, 10833 Le Conte Ave., Los Angeles, CA 90095. Electronic address: kimcr316@gmail.com.
authors.forename: Caron R
authors.initials: CR
authors.lastname: Kim
authors.affiliation: University of California, Los Angeles, Department of Obstetrics and Gynecology, 10833 Le Conte Ave., Los Angeles, CA 90095.
authors.forename: Otoniel
authors.initials: O
authors.lastname: Martinez-Maza
authors.affiliation: University of California, Los Angeles, Department of Obstetrics and Gynecology, 10833 Le Conte Ave., Los Angeles, CA 90095.
authors.forename: Larry
authors.initials: L
authors.lastname: Magpantay
authors.affiliation: University of California, Los Angeles, Department of Obstetrics and Gynecology, 10833 Le Conte Ave., Los Angeles, CA 90095.
authors.forename: Clara
authors.initials: C
authors.lastname: Magyar
authors.affiliation: University of California, Los Angeles, Department of Obstetrics and Gynecology, 10833 Le Conte Ave., Los Angeles, CA 90095.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Gornbein
authors.affiliation: University of California, Los Angeles, Department of Obstetrics and Gynecology, 10833 Le Conte Ave., Los Angeles, CA 90095.
authors.forename: Radhika
authors.initials: R
authors.lastname: Rible
authors.affiliation: University of California, Los Angeles, Department of Obstetrics and Gynecology, 10833 Le Conte Ave., Los Angeles, CA 90095.
authors.forename: Peggy
authors.initials: P
authors.lastname: Sullivan
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D016207:Cytokines / Q000097:blood*; D004717:Endometrium / Q000276:immunology*; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D007436:Intrauterine Devices, Medicated; D016912:Levonorgestrel / Q000008:administration & dosage*; D010865:Pilot Projects; D066027:Transplant Recipients; D055815:Young Adult
chemical_list: D016207:Cytokines; D016912:Levonorgestrel
keywords: Endometrium; Immunology; Intrauterine device; Transplant