Influence of Pretransplant Pregnancy on Survival of Renal Allografts from Offspring Donors

Sim, Won Sub; Lim, Duck Sang; Kim, Song Cheol; Han, Duck Jong

Abstract

PURPOSE
The pretransplant pregnancy has been thought to be a detrimental factor for graft survival following renal allografts. However, graft survival in woman who underwent renal allografts from her offspring donor can be affected either positively by chimerism during fetal circulation or negatively by hypersensitive response. We attempted to define the role of pretransplant pregnancy on allografts survival of mother recipients from offspring donors.
METHODS
During July 1, 1990 through July 31, 2002 117 patients were enrolled in this study. We divided these patients into 3 groups: group 1 (mothers receiving allografts from offspring) of 40 patients, group 2 (fathers receiving allografts from offspring) of 42 patients, and group 3 (women with a history of pregnancy and received allografts from unrelated donors) of 35 patients. We analysed the rejection rate, and patient and graft survival among the 3 groups.
RESULTS
The acute rejection episodes (ARE) within 3 months were prevalent in the patients who received allografts from offspring. But after 3 months, no significant difference was observed among the three groups. The 1, 5 years graft survival rate of each group was 90.0%, 85.5% in group 1, 97.4%, 97.4% in group 2 and 94.3%, 94.3% in group 3. And the 1, 5 years patient survival rate was 92.5%, 88.1% in group 1, 100%, 100% in group 2 and 94.3%, 94.3% in group 3.
CONCLUSION
From these results we can assume that the higher rejection rate and somewhat lower graft survival rate in mother recipients who underwent renal allografts from the offspring donors were caused by the anamnestic response from presensitization during pregnancy. To achieve better results in this group, a perioperative cautious care with different strategy of immunosuppressant is recommended.