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• W2973162166 abstract "Duval et al.1Duval A. Olagne J. Cognard N. et al.Pregnancy in a kidney transplant woman under treatment with eculizumab for atypical hemolytic uremic syndrome: is it safe?.Kidney Int Rep. 2019; 4: 733-739Abstract Full Text Full Text PDF PubMed Scopus (8) Google Scholar recently described a kidney transplant recipient who developed atypical hemolytic uremic syndrome, and was treated with eculizumab during pregnancy with a successful outcome. We described a similar case recently (Cheung CK, Evans K, Williams M, et al. A successful pregnancy in a patient following renal transplantation for atypical HUS managed with eculizumab. UK Kidney Week; June 2018. Available at: https://britishrenal.org/ukkw2018-2/abstracts-2/. Accessed September 29, 2019). Our case was a 24-year-old woman, with end-stage renal disease of uncertain etiology who underwent a live kidney transplant. Subsequently, a transplant biopsy for graft deterioration showed recurrent atypical hemolytic uremic syndrome. She was commenced on eculizumab 1200 mg every 2 weeks, and her graft function stabilized (estimated glomerular filtration rate 45 ml/min per 1.73 m2). She later expressed a desire to become pregnant, did not have significant proteinuria, and was taking tacrolimus and azathioprine. After becoming pregnant, her eculizumab dose was increased at 16 weeks (Table 1), with monitoring for hemolysis and complement activity (C3, C4, C5, CH50, AH50 assays) every 2 weeks. At 29+5/40, she developed edema, hypertension, increased proteinuria, decline in renal function and platelets, and increased lactate dehydrogenase. An emergency cesarean delivery was performed, and placental histopathology later confirmed preeclampsia. A female infant weighing 950 g was delivered, with patent ductus arteriosus (which subsequently closed), and was fed with expressed breastmilk. The patient was given two 900-mg eculizumab infusions in the first postnatal week, which was later reduced. Hemoglobin and platelets stabilized, and kidney function returned to prepregnancy levels. Total complement activity remained suppressed throughout pregnancy. Both mother and child are currently well.Table 1Eculizumab dosing during the pregnancyGestational ageEculizumab dosage, mgInfusion frequencyBooking1200Every 2 wk16 wk1500Every 2 wk28 wk900WeeklyWithin 24 h of delivery900Additional infusion7 d postnatal1200Weekly14 d postnatal1200Every 2 wk Open table in a new tab These reports suggest that preemptive increased dosing of eculizumab to prevent breakthrough haemolysis, with close monitoring for hemolysis and complement activity, represents a safe and viable strategy during pregnancy in kidney transplant recipients with atypical hemolytic uremic syndrome. Pregnancy in a Kidney Transplant Woman Under Treatment With Eculizumab for Atypical Hemolytic Uremic Syndrome: Is It Safe?Kidney International ReportsVol. 4Issue 5PreviewEculizumab, a humanized IgG2/4 chimeric monoclonal antibody against complement protein C5, is the first drug that specifically targets complement activation. Initially approved for paroxysmal nocturnal hemoglobinuria (PNH), its indications have been subsequently extended to the treatment of atypical hemolytic uremic syndrome (aHUS).1 Currently, eculizumab also is being used for treating or preventing aHUS recurrences after kidney transplantation, with a significant positive impact on clinical outcomes and quality of life. Full-Text PDF Open AccessThe Authors ReplyKidney International ReportsVol. 4Issue 11PreviewWe thank Cheung et al.1 for their valuable comment and their contribution to the literature by describing a second case of successful pregnancy in a kidney transplant recipient receiving eculizumab for atypical hemolytic uremic syndrome. Full-Text PDF Open Access" @default.
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• W2973162166 date "2019-11-01" @default.
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• W2973162166 title "Use of Eculizumab During Pregnancy in Kidney Transplant Recipients With Atypical HUS" @default.
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• W2973162166 doi "https://doi.org/10.1016/j.ekir.2019.08.020" @default.
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