Outcome of Husband-to-Wife Kidney Transplantation With Mutual Children: Single Center Experience Using T Cell-Depleting Induction and Review of the Literature.

Lisa Senn,Jürg Steiger,Michael Dickenmann,Patrizia Amico,Stefan Schaub,Irene Geiger,Patricia Hirt-Minkowski,Gideon Hönger,Caroline Wehmeier

doi:10.3389/fmed.2021.724851

Lisa Senn, Jürg Steiger + Show 7 more

Open Access

https://doi.org/10.3389/fmed.2021.724851

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Abstract

Few data on husband-to-wife transplantations with mutual children (H2W) exist in the current era. We investigated the outcome of H2W transplantations (n = 25) treated with T cell-depleting induction compared to women with prior pregnancies also receiving their first HLA-mismatched kidney transplant, but from a different donor source: (i) other living donor (n = 52) and (ii) deceased donor (n = 120). Seventy-four percent of the women had ≥2 pregnancies; median follow-up time was 5 years. Death-censored allograft survival was significantly lower in the H2W group compared to the other two groups (p = 0.03). Three of four graft losses in the H2W group were due to rejection. 5-year patient survival in the H2W group was high and similar compared to the other living donor group (100 vs. 98%; p = 0.28). The incidence of (sub)clinical antibody-mediated rejection was higher in the H2W group (36 vs. 20 vs. 18%) (p = 0.10). The frequency of infections was similar among the three groups. No immunological parameter was predictive for rejection or graft loss in H2W transplantations. In conclusion, H2W transplantation is a valuable option, but associated with a higher risk for allograft loss due to rejection despite T cell-depleting induction. Further research is required for better risk prediction on an individual patient level.

Highlights

IntroductionUsing sensitive single antigen bead assays on the Luminex platform, child-specific HLA-directed antibodies are detected immediately after delivery in about 20–30% of women after one pregnancy and almost 50% after three or more pregnancies [1]
Pregnancy is an important reason for HLA-directed sensitization
The key observation is this study was that despite T celldepleting induction, H2W transplantations have a higher risk for death-censored graft loss possibly mediated by a higher frequency of antibodymediated rejection (ABMR) compared to other HLAmismatched living or deceased donor transplantations in women with prior pregnancies

Summary

Introduction

Using sensitive single antigen bead assays on the Luminex platform, child-specific HLA-directed antibodies are detected immediately after delivery in about 20–30% of women after one pregnancy and almost 50% after three or more pregnancies [1]. This suggests that repeated exposures to the same HLA molecules increases the likelihood of a detectable humoral immune response [2, 3]. As sera dating back to the immediate time after delivery are very rarely available, sensitization cannot be excluded, even if no HLA antibodies are detectable in current sera This is a major diagnostic challenge in husband-to-wife transplantations with mutual children (H2W), because there will be a 20–50% chance of prior husband-specific sensitization depending on the number of pregnancies. Several case reports/series demonstrated that severe early rejection can occur in H2W transplantations despite the absence of detectable HLA antibodies prior to transplantation [7,8,9,10]

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