Pregnancy after renal transplant

Pregnancy after renal transplant - Sheena Surindran MD...

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Unformatted text preview: Sheena Surindran MD 7/12/2011 32 yr old AAF with PMH of DM type 1 , s/p DDKT x 2 presents to renal clinic for prenatal counseling. 1 st transplant immediate graft non function due to thrombosis 2 nd transplant 6 months ago Currently on Tacrolimus, MMF and steroids What are your recommendation? What further information would you like? Colorado birth and death certificate from 1989 2001 911 births from women with kidney disease and 4606 births from women without kidney ds Women with kidney ds had adverse fetal (18.2% vs 9.5%) and maternal (13.7% vs 4.3%) outcomes p<0.001. this is independent of other risk factors. American Journal of Kidney Diseases, Vol 43, No 3 (March), 2004 Incidence is about 7% 40 60% successful outcome, 85% infants premature Adverse maternal outcomes includes preeclampsia, eclampsia or abruptio placenta Mechanisms develop to promote maternal tolerance to fetus and fetal tolerance to mother to prevent fetal loss and inflammation Cyclical changes in immune system occur in women to protect fetus Maternal tolerance to fetus is dependent on CD25+ regulatory cells which expand 3 4fold during pregnancy but returns to pre pregnancy levels post partum. The exact mechanism by which this happens is unknown. EVT cells neither express MHC class 1 or class II which are the main targets for alloreactive T cells in transplant rejection and thus evade immune attack by T cells Systemic immunosupression would be disadvantageous as it would weaken this system by suppressing T regs Immunological Reviews 241/2011 Observational study using medicare claims data 16195 txp patients between 1990 2003 Excluded repeat txp and multiple organs Used to calculate population based live birth rates and pregnancy rates Pregnancy rate 33 per 1000 females txp pts...
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This note was uploaded on 12/24/2011 for the course STEP 1 taught by Professor Dr.aslam during the Fall '11 term at Montgomery College.

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Pregnancy after renal transplant - Sheena Surindran MD...

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