Successful Pregnancies During Ongoing Eculizumab Therapy in Two Patients With Complement-Mediated Thrombotic Microangiopathy
| Autor: | Christof Aigner, Alice Schmidt, Georg A. Böhmig, Natalja Haninger-Vacariu, Renate Kain, Gere Sunder-Plassmann, Zoltán Prohászka, Raute Sunder-Plassmann, Leah Charlotte Piggott, Martina Gaggl |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
renal failure Thrombotic microangiopathy Renal function kidney transplantation Case Report Complement factor I childbirth lcsh:RC870-923 Gastroenterology complement blockade gestation Internal medicine Internal Medicine medicine complement-mediated thrombotic microangiopathy (cTMA) Kidney transplantation complement system Pregnancy business.industry Eculizumab medicine.disease lcsh:Diseases of the genitourinary system. Urology Atypical hemolytic uremic syndrome (aHUS) Nephrology Cord blood complement factor Gestation eculizumab pregnancy gravidity business chronic kidney disease medicine.drug |
| Zdroj: | Kidney Medicine Kidney Medicine, Vol 2, Iss 2, Pp 213-217 (2020) |
| ISSN: | 2590-0595 |
| Popis: | In patients with pregnancy-associated complement gene variant–mediated thrombotic microangiopathy (cTMA), terminal complement blockade is used for treatment of cTMA flares during pregnancy or following delivery. We report pregnancy and delivery outcomes of 2 genetically high-risk patients with cTMA, including 1 kidney transplant recipient, during ongoing eculizumab therapy. In both patients, the first manifestation of cTMA occurred independent from pregnancy. One patient has a history of 2 uneventful pregnancies with prophylactic plasma infusions, and the other has a history of early abortion during long-term eculizumab therapy following kidney transplantation. Overall, pregnancy and delivery outcomes under ongoing eculizumab therapy in our 2 patients with preserved kidney function were excellent as compared with other patients reported in the literature. Eculizumab plasma concentrations were maintained in the therapeutic range during pregnancy and were also detectable in cord blood. Results of cord blood analysis showed deficient complement activity, with low factor and regulator levels, most likely reflecting the age of the neonates and presence of eculizumab in cord blood. In conclusion, pregnancy during ongoing eculizumab treatment appeared to be safe in 2 women with a history of high-risk genetic cTMA and excellent kidney function, even following kidney transplantation. Index Words: Atypical hemolytic uremic syndrome (aHUS), complement-mediated thrombotic microangiopathy (cTMA), complement system, complement factor, complement blockade, eculizumab, pregnancy, gravidity, childbirth, gestation, kidney transplantation, chronic kidney disease, renal failure |
| Databáze: | OpenAIRE |
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