Immunological Status of Children Born to Female Liver Recipients

Abstract

BackgroundImmunosuppressive treatment in pregnant organ recipients can affect functions of the fetal and newborn immune system. The aim of this study was to evaluate the effect of this treatment on selected parameters of the immune system of children born to mothers after liver transplantation.Material/MethodsThe study included 52 children born to liver recipients and 52 children in the control group. The study was conducted in the 1st Department of Obstetrics and Gynecology, Medical University of Warsaw. Children from the 1st day of life to 10 years of age were examined. Serum antibody concentrations of IgG, IgM, and IgA were measured by the immune agglutination method on a Cobas 6000 analyzer.ResultsComparison of mean IgG, IgM, and IgA levels and with reference values did not show a significant difference between the study and control group (p>0.05). Immunoglobulin concentrations were also analyzed in the groups of children according to their age at the time of the test and the type of calcineurin inhibitor used in the mother’s treatment. The analysis showed a significant difference in the distribution of IgA concentrations in comparison to the normal values (p<0.05), as well as mean IgA (p<0.05) and IgM concentrations (p<0.05) according to the type of immunosuppressive treatment of the mother (tacrolimus or cyclosporin treatment regimen).ConclusionsAnalysis of the type of immunosuppressive therapy used during pregnancy revealed a possible influence of the type of calcineurin inhibitor on selected parameters of the immune system of the children; however, further research is needed to confirm these findings.

The Effect of In Utero Exposure to Maternal Inflammatory Bowel Disease and Immunomodulators on Infant Immune System Development and Function

“…In neonates, infants, and children older than 1 year, in utero exposure to tacrolimus, cyclosporin, glucocorticoids, and/or azathioprine for maternal transplantation was not shown to result in significant changes in the serum abundance of immunoglobulins, barring higher IgA in mothers treated with cyclosporin as opposed to tacrolimus, and lower IgG1 and IgG3 in cyclosporin-exposed infants as opposed to healthy controls. 126 , 127 T cell proportions and B cell subtype populations were comparable to controls; however, in relevant studies, CD45RA+RO- naïve T cells were increased in cyclosporin-exposed children aged from newborn to 10 years of age, whereas CD45RA-RO+ memory T cells were more numerous in azathioprine-exposed children, suggesting delayed T cell maturation for cyclosporin, and accelerated T cell maturation for azathioprine. 126 , 127 , 131 In another study assessing cyclosporin-exposed infants over the first year of life, CD25 expression on T cells and CD5 expression on B cells did not increment over time, and B (including Bregs) and Treg numbers were decreased at birth.…”

“… 126 , 127 T cell proportions and B cell subtype populations were comparable to controls; however, in relevant studies, CD45RA+RO- naïve T cells were increased in cyclosporin-exposed children aged from newborn to 10 years of age, whereas CD45RA-RO+ memory T cells were more numerous in azathioprine-exposed children, suggesting delayed T cell maturation for cyclosporin, and accelerated T cell maturation for azathioprine. 126 , 127 , 131 In another study assessing cyclosporin-exposed infants over the first year of life, CD25 expression on T cells and CD5 expression on B cells did not increment over time, and B (including Bregs) and Treg numbers were decreased at birth. 127 The clinical significance of these abnormalities appeared to be minimal, with no increases in immunodeficiencies or autoimmune disorders reported in the included infants.…”

“… 129 CD45RA+RO- naïve T cells increased in cyclosporin-exposed children CD45RA-RO+ memory T cells more numerous in azathioprine-exposed children. 126 , 127 , 130 , 131 CD25 expression on T cells and CD5 expression on B cells fails to increment over time. 127 Decreased Treg numbers at birth.…”

“… Lower IgG1 and IgG3 in cyclosporin-exposed infants as opposed to healthy controls. 126 , 127 OR of 1.32 (95% CI, 1.2–1.4) for serious infections, 3.72 (95% CI, 3.0–4.6) for serious infections. 120 HR of 0.57 (95% CI, 0.4–0.9) for viral opportunistic infections in comparison to subjects receiving anti-TNF.…”

Usage of Tacrolimus and Mycophenolic Acid During Conception, Pregnancy, and Lactation, and Its Implications for Therapeutic Drug Monitoring: A Systematic Critical Review

“…66 Drozdowska-Szymczak et al observed no significant differences in immunoglobulin concentrations at birth between infants born to mothers on Tac treatment after SOT and those born to healthy mothers. 67,68 Kociszewska-Najman et al 69 reported that white blood cell counts within the first 72 hours after birth were within the normal limits.…”