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Johannesson L, Sawinski D, Vock DM, Kristek J, Fronek J, Richards EG, O’Neill KE, Perni U, Porrett PM, Testa G. A Multi-Institutional Report of Intermediate-Term Kidney Outcomes in Uterus Transplant Recipients. Kidney Int Rep 2023; 8:2156-2159. [PMID: 37850013 PMCID: PMC10577357 DOI: 10.1016/j.ekir.2023.07.036] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 07/25/2023] [Accepted: 07/31/2023] [Indexed: 10/19/2023] Open
Affiliation(s)
- Liza Johannesson
- Division of Obstetrics and Gynecology, Baylor University Medical Center, Dallas, Texas, USA
- Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center, Dallas, Texas, USA
| | - Deirdre Sawinski
- Division of Nephrology and Transplantation, Weill Cornell Medical College, New York, New York, USA
| | - David M. Vock
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Jakub Kristek
- Department of Transplantation Surgery, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
- Department of Anatomy, Second Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Jiri Fronek
- Department of Transplantation Surgery, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
- Department of Anatomy, Second Faculty of Medicine, Charles University, Prague, Czech Republic
- First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Elliott G. Richards
- Obstetrics and Gynecology and Women’s Health Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Kathleen E. O’Neill
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Uma Perni
- Obstetrics and Gynecology and Women’s Health Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Paige M. Porrett
- Comprehensive Transplant Institute, University of Alabama at Birmingham, Birmingham Alabama, USA
| | - Giuliano Testa
- Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center, Dallas, Texas, USA
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Sawinski D, Johannesson L, Kristek J, Fronek J, O'Neill KE, Gregg A, Testa G, Porrett PM. A multi-institutional study of renal outcomes and renal-related pregnancy outcomes in uterus transplant recipients. Am J Transplant 2022; 22:3101-3110. [PMID: 35822437 DOI: 10.1111/ajt.17149] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 06/16/2022] [Accepted: 07/03/2022] [Indexed: 01/25/2023]
Abstract
Uterus transplantation (UTx) is an effective treatment option for uterine factor infertility. However, the need for immunosuppression and congenital renal anomalies that coexist with uterine agenesis in about 30% of women with Mayer-Rokitansky-Kuster-Hauser syndrome create a risk for renal dysfunction. We therefore examined renal function trajectory and related pregnancy complications in an international cohort of 18 UTx recipients from September 2016-February 2020 who had at least one live birth. All UTx recipients had a diminution in their renal function that was apparent starting at 30 days posttransplant and in half the reduction in eGFR was at least 20%; the decrease in eGFR persisted into the early post-partum period. Half met criteria for Stage 1 acute kidney injury (AKI) as defined by the AKI Network criteria during their pregnancy. Overall, 28% of UTx recipients developed pre-eclampsia. eGFR was lower at embryo transfer and throughout pregnancy among those who developed pre-eclampsia, reaching statistical significance at week 16 of pregnancy. This effect was independent of tacrolimus levels. Mean eGFR remained significantly lower in the first 1-3 months after delivery. In the subgroup who reached 12 months of postpartum follow up and had a graft hysterectomy (n = 4), there was no longer a statistical difference in eGFR (pretransplant 106.7 ml/m ± 17.7 vs. 12 mos postpartum 92.6 ml/m ± 21.7, p = .13) but the number was small. Further study is required to delineate long term renal risks for UTx recipients, improve patient selection, and make decisions regarding a second pregnancy.
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Affiliation(s)
- Deirdre Sawinski
- Division of Nephrology and Transplantation, Weill Cornell Medical College, New York, New York, USA
| | - Liza Johannesson
- Division of Obstetrics and Gynecology, Baylor University Medical Center, Dallas, Texas, USA.,Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center, Dallas, Texas, USA
| | - Jakub Kristek
- Department of Transplantation Surgery, Institute for Clinical and Experimental Medicine, Prague, Czech Republic.,Department of Anatomy, Second Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Jiri Fronek
- Department of Transplantation Surgery, Institute for Clinical and Experimental Medicine, Prague, Czech Republic.,Department of Anatomy, Second Faculty of Medicine, Charles University, Prague, Czech Republic.,First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Kathleen E O'Neill
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Anthony Gregg
- Department of Obstetrics and Gynecology, Prisma Health, Columbia, South Carolina, USA
| | - Giuliano Testa
- Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center, Dallas, Texas, USA
| | - Paige M Porrett
- Comprehensive Transplant Institute, University of Alabama at Birmingham, Birmingham, Alabama, USA
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