Thoracic organ transplantation and pregnancy outcomes: systematic review and meta-analysis

Jha, Nivedita; Jha, Ajay Kumar; Mishra, Sandeep Kumar; Parida, Satyen

doi:10.1007/s00404-023-07065-x

Cited by 3 publications

(1 citation statement)

References 37 publications

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“…Organ transplant recipients represent an immunomodulated population who have reduced numbers of circulating NK cells (34,35) and rates of pre-eclampsia that are sixfold greater than the general population (36)(37)(38)(39)(40)(41). Despite the prevalence of pregnancy complications in organ transplant recipients, the biologic basis for this increased risk is unknown (42).…”

Section: Introductionmentioning

confidence: 99%

Inhibition of NFAT promotes loss of tissue resident uterine natural killer cells and attendant pregnancy complications in humans

Asiimwe,

Knott,

Greene

et al. 2024

Preprint

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Uterine natural killer cells (uNKs) are a tissue resident lymphocyte population that are critical for pregnancy success. Although mouse models have demonstrated that NK deficiency results in abnormal placentation and poor pregnancy outcomes, the generalizability of this knowledge to humans remains unclear. Here we identify uterus transplant (UTx) recipients as a human population with reduced endometrial NK cells and altered pregnancy phenotypes. We further show that the NK reduction in UTx is due to impaired transcriptional programming of NK tissue residency due to blockade of the transcription factor nuclear factor of activated T cells (NFAT). NFAT-dependent genes played a role in multiple molecular circuits governing tissue residency in uNKs, including early residency programs involving AP-1 transcription factors as well as TGFβ-mediated upregulation of surface integrins. Collectively, our data identify a previously undescribed role for NFAT in uterine NK tissue residency and provide novel mechanistic insights into the biologic basis of pregnancy complications due to alteration of tissue resident NK subsets in humans.One Sentence SummaryRole of NFAT in uterine NK cell tissue residency

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Section: Introductionmentioning

confidence: 99%

Inhibition of NFAT promotes loss of tissue resident uterine natural killer cells and attendant pregnancy complications in humans

Asiimwe,

Knott,

Greene

et al. 2024

Preprint

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Adverse Pregnancy Outcomes in Solid Organ Transplant Recipients

Yo,

Fields,

et al. 2024

JAMA Netw Open

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ImportanceTransplant recipients experience high rates of adverse pregnancy outcomes; however, contemporary estimates of the association between solid organ transplantation and adverse pregnancy outcomes are lacking.ObjectiveTo evaluate the association between solid organ transplantation and adverse pregnancy outcomes and to quantify the incidence of allograft rejection and allograft loss during pregnancy.Data SourcesPubMed/MEDLINE, EMBASE and Scopus databases were searched from January 1, 2000, to June 20, 2024, and reference lists were manually reviewed.Study SelectionCohort and case-control studies that reported at least 1 adverse pregnancy outcome in pregnant women with solid organ transplantation vs without solid organ transplant or studies that reported allograft outcomes in pregnant women with solid organ transplantation were included following independent dual review of abstracts and full-text articles.Data Extraction and SynthesisTwo investigators abstracted data and independently appraised risk of bias using the Newcastle Ottawa Scale. A random-effects model was used to calculate overall pooled estimates using the DerSimonian-Laird estimator. Reporting followed the Meta-analysis of Observational Studies in Epidemiology (MOOSE) reporting guideline.Main Outcomes and MeasuresPrimary pregnancy outcomes were preeclampsia, preterm birth (&lt;37 weeks), and low birth weight (&lt;2500 g). Secondary pregnancy outcomes were live birth rate, gestation, very preterm birth (&lt;32 weeks), very low birth weight (&lt;1500 g), and cesarean delivery. Allograft outcomes were allograft loss and rejection during pregnancy.ResultsData from 22 studies and 93 565 343 pregnancies (4786 pregnancies in solid organ transplant recipients) were included; 14 studies reported adverse pregnancy outcomes, and 13 studies provided data for allograft outcomes. Pregnancies in organ transplant recipients were associated with significantly increased risk of preeclampsia (adjusted odds ratio [aOR], 5.83 [95% CI, 3.45-9.87]; I2 = 77.4%), preterm birth (aOR, 6.65 [95% CI, 4.09-12.83]; I2 = 81.8%), and low birth weight (aOR, 6.51 [95% CI, 2.85-14.88]; I2 = 90.6%). The incidence of acute allograft rejection was 2.39% (95% CI, 1.20%-3.96%; I2 = 68.5%), and the incidence of allograft loss during pregnancy was 1.55% (95% CI, 0.05%-4.44%; I2 = 69.2%).Conclusions and RelevanceIn this systematic review and meta-analysis, pregnancies in recipients of a solid organ transplant were associated with a 4 to 6 times increased risk of preeclampsia, preterm birth, and low birth weight during pregnancy. There was a low overall risk of graft rejection or loss during pregnancy.

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Examining the impact of solid organ transplantation on family planning: pre- and post-transplantation pregnancy evaluations for both women and men

Böhm,

Schirm,

Zimmermann

et al. 2024

Arch Gynecol Obstet

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Purpose The aim of this study was to collect and analyze information from pregnancies of organ transplanted women and partners of organ transplanted men. The goal was to enhance counseling regarding pregnancy planning and management and to enable more targeted monitoring to improve maternal and child health. Methods In this retrospective, multicenter cohort study, women and men aged 18 to 45 who had undergone organ transplantation in Germany, Austria, and Switzerland were surveyed about their pregnancies before and after transplantation by using a self-developed questionnaire. Results Even through transplanted women planned their pregnancies more carefully than before transplantation, they still experienced more pregnancy complications afterward. The live birth rate for pregnancies of partners of transplanted men, especially men who received a thoracic organ, was lower compared to before transplantation. Furthermore, this study showed that pregnancies of the partners of male transplant recipients occurred significantly less by spontaneous conception in comparison to pregnancies of transplanted women. Conclusion Pregnancies after organ transplantation are possible but associated with an increased risk of pregnancy complications. Therefore, early counseling for transplanted women and men who wish to have children, along with extensive monitoring during pregnancy, is necessary.

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Thoracic organ transplantation and pregnancy outcomes: systematic review and meta-analysis

Cited by 3 publications

References 37 publications

Inhibition of NFAT promotes loss of tissue resident uterine natural killer cells and attendant pregnancy complications in humans

Inhibition of NFAT promotes loss of tissue resident uterine natural killer cells and attendant pregnancy complications in humans

Adverse Pregnancy Outcomes in Solid Organ Transplant Recipients

Examining the impact of solid organ transplantation on family planning: pre- and post-transplantation pregnancy evaluations for both women and men

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