Complex chimerism

Kimberly, K.; Petroff, Margaret G.; Coscia, Lisa A.; Armenti, Vincent T.; Waldorf, Kristina M. Adams

doi:10.4161/chim.25401

Cited by 20 publications

(5 citation statements)

References 78 publications

(83 reference statements)

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“…Previous pregnancies and blood transfusions may have added other cell populations. The tolerance system is complex and not all antigens induce a response; tolerance may be the result of exposure of particular antigens or complexes [ 132 ].…”

Section: Which Patients Are the “Best Candidates” For Pregnancy Aftermentioning

confidence: 99%

“…The postpartum period is also of pivotal importance: the acute loss of the placenta, which was a primary driver of tolerance, could theoretically trigger rejection, while the decrease of interleukin (IL)-10 and estrogen levels may counterbalance this effect [ 132 , 133 ]. Acute kidney injury (AKI) is a relatively unexplored syndrome post-partum, and new data suggest in particular to pay attention to the use of anti-fibrinolytic agents [ 134 ].…”

Section: Which Patients Are the “Best Candidates” For Pregnancy Aftermentioning

confidence: 99%

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A best-practice position statement on pregnancy after kidney transplantation: focusing on the unsolved questions. The Kidney and Pregnancy Study Group of the Italian Society of Nephrology

et al. 2018

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Kidney transplantation (KT) is often considered to be the method best able to restore fertility in a woman with chronic kidney disease (CKD). However, pregnancies in KT are not devoid of risks (in particular prematurity, small for gestational age babies, and the hypertensive disorders of pregnancy). An ideal profile of the potential KT mother includes “normal” or “good” kidney function (usually defined as glomerular filtration rate, GFR ≥ 60 ml/min), scant or no proteinuria (usually defined as below 500 mg/dl), normal or well controlled blood pressure (one drug only and no sign of end-organ damage), no recent acute rejection, good compliance and low-dose immunosuppression, without the use of potentially teratogen drugs (mycophenolic acid and m-Tor inhibitors) and an interval of at least 1–2 years after transplantation. In this setting, there is little if any risk of worsening of the kidney function. Less is known about how to manage “non-ideal” situations, such as a pregnancy a short time after KT, or one in the context of hypertension or a failing kidney. The aim of this position statement by the Kidney and Pregnancy Group of the Italian Society of Nephrology is to review the literature and discuss what is known about the clinical management of CKD after KT, with particular attention to women who start a pregnancy in non-ideal conditions. While the experience in such cases is limited, the risks of worsening the renal function are probably higher in cases with markedly reduced kidney function, and in the presence of proteinuria. Well-controlled hypertension alone seems less relevant for outcomes, even if its effect is probably multiplicative if combined with low GFR and proteinuria. As in other settings of kidney disease, superimposed preeclampsia (PE) is differently defined and this impairs calculating its real incidence. No specific difference between non-teratogen immunosuppressive drugs has been shown, but calcineurin inhibitors have been associated with foetal growth restriction and low birth weight. The clinical choices in cases at high risk for malformations or kidney function impairment (pregnancies under mycophenolic acid or with severe kidney-function impairment) require merging clinical and ethical approaches in which, beside the mother and child dyad, the grafted kidney is a crucial “third element”.

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Section: Which Patients Are the “Best Candidates” For Pregnancy Aftermentioning

confidence: 99%

Section: Which Patients Are the “Best Candidates” For Pregnancy Aftermentioning

confidence: 99%

A best-practice position statement on pregnancy after kidney transplantation: focusing on the unsolved questions. The Kidney and Pregnancy Study Group of the Italian Society of Nephrology

et al. 2018

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“…We can hypothesise that invasive tests such as transbronchial biopsies were not likely to be performed during pregnancy and thus acute rejection might have been underdiagnosed. Nonetheless, some authors describe possible immunotolerance mechanisms during pregnancy due to a decreased T-lymphocyte response [19]. In the post-partum period, we reported four acute rejections in two patients within the 6 months following childbirth.…”

Section: Discussionmentioning

confidence: 70%

Pregnancy after lung and heart–lung transplantation: a French multicentre retrospective study of 39 pregnancies

et al. 2019

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Pregnancy after lung and heart–lung transplantation remains rare. This French study deals with change in lung function after a pregnancy and the maternal and newborn outcomes.We retrospectively included 39 pregnancies in 35 women aged >20 years. Data on patients, course of pregnancies and newborns were collected from nine transplantation centres.Mean age at time of pregnancy was 28 years. Cystic fibrosis affected 71% of patients. Mean±sd time between transplantation and pregnancy was 63±44 months. 26 births occurred (67%) with a mean term of 36 weeks of amenorrhoea and a mean birthweight of 2409 g. Prematurity was observed in 11 cases (43%). Forced expiratory volume in 1 s was 83.9% of predicted before pregnancy and 77.3% of predicted 1 year after the end of pregnancy (p=0.04). 10 patients developed chronic lung allograft dysfunction after delivery. Nine patients died at a mean±sd time after transplantation of 8.2±7 years and a mean±sd time after pregnancy of 4.6±6.5 years.These data show that pregnancy remains feasible in lung and heart–lung transplant recipients, with more frequent maternal and newborn complications than in the general population. Survival in this cohort appears to be similar to the global survival observed in lung transplant recipients. Planned pregnancy and multidisciplinary follow-up are crucial.

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“…On the other hand, there are theories that an increased quantity of allograft tissue in the host’s body ameliorates the risk of rejection owing to the higher antigen load of the combined transplant or the large number of passenger leukocytes originating from the lymphoid rich pancreatico-duodenal component of the double allograft 36 . Good allograft tolerance in pregnancy might have grounds in chimerism in maternal, fetal, and donor cell populations, as proposed by Ma et al 45 . An increased risk of graft loss in pregnancy during the first and second year after transplantation, but not in the third year, was observed by Rose et al 46 .…”

Section: Graft Rejection In Pregnant Spkt Recipientsmentioning

confidence: 91%

Pregnancy After Simultaneous Pancreas-Kidney Transplantation in Treatment of End-Stage Diabetes Mellitus: a Review

Stanić

Vulić

Hrgović

et al. 2021

Z Geburtshilfe Neonatol

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The majority of patients with simultaneous pancreas and kidney transplant (SPKT) required transplantation owing to a long-standing history of insulin-dependent diabetes mellitus (IDDM). The disease causes multiple organ damage, impairs fertility, and affects quality of life. A successful kidney and pancreas transplant can improve health, ameliorate the consequences of pre-existent diabetes, and restore fertility. Good graft function, without any sign of rejection, and stable doses of immunosuppressant drugs are of utmost importance prior to the planned pregnancy. SPKT recipients who become pregnant may be at an increased risk for an adverse outcome and require meticulous multidisciplinary surveillance. We present experiences with SPKT pregnancies, traditional approaches, and recent considerations. In light of complex interactions between new anatomic relations and the impact of developing pregnancy and immunosuppressive medications, special stress is put on the risk of graft rejection, development of pregnancy complications, and potential harmful effects on fetal development. Recent recommendations in management of SPKT recipients who wish to commence pregnancy are presented as well. Key words: transplantation, pregnancy, pancreas, kidney, simultaneous pancreas and kidney transplantation (SPKT)

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Complex chimerism

Cited by 20 publications

References 78 publications

A best-practice position statement on pregnancy after kidney transplantation: focusing on the unsolved questions. The Kidney and Pregnancy Study Group of the Italian Society of Nephrology

A best-practice position statement on pregnancy after kidney transplantation: focusing on the unsolved questions. The Kidney and Pregnancy Study Group of the Italian Society of Nephrology

Pregnancy after lung and heart–lung transplantation: a French multicentre retrospective study of 39 pregnancies

Pregnancy After Simultaneous Pancreas-Kidney Transplantation in Treatment of End-Stage Diabetes Mellitus: a Review

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