Abstract: TH-PO765
Successful Use of Eculizumab for Prevention of Atypical Hemolytic Uremic Syndrome Recurrence in a Pregnant Kidney Transplant Recipient with CFH Gene Mutation: A Case Report and Literature Review
Session Information
- Transplantation: Clinical - 1
October 24, 2024 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 2102 Transplantation: Clinical
Authors
- Zahran, Somaya, McGill University, Montreal, Quebec, Canada
- Nodzynski, Thomas, Hopital general du Lakeshore, Pointe-Claire, Quebec, Canada
- Matte, Catherine, Anna Laberge Hospital, Montreal, Quebec, Canada
- Sandal, Shaifali, McGill University, Montreal, Quebec, Canada
- Podymow, Tiina, McGill University, Montreal, Quebec, Canada
- Cantarovich, Marcelo, McGill University, Montreal, Quebec, Canada
Introduction
Eculizumab is a humanized monoclonal antibody targeting C5, used in the treatment of atypical hemolytic uremic syndrome (aHUS). It is accepted as maintenance therapy for the prevention of recurrent aHUS post kidney transplant (KTx), however, clinical experience with its use during pregnancy is limited.
Case Description
36-year-old woman with history of end stage renal disease secondary to aHUS with confirmed complement factor H gene mutation was treated with hemodialysis, plasmapheresis, rituximab and vincristine. She received a standard-criteria deceased donor KTx in 2013. Eculizumab was administered in the perioperative period at a dose of 1200 mg IV, followed by 1200 mg Q1W for 2 weeks, and then Q2W thereafter as maintenance therapy. In 2016, she had a planned pregnancy during which eculizumab was continued. Biomarkers of hemolysis and kidney function were closely monitored. Despite the development of pre-eclampsia resulting in preterm delivery at 33W, the patient delivered a healthy infant and had well-preserved allograft function with no aHUS recurrence. 8 years later, no complications are observed and her child is developing normally.
Pubmed search was conducted for reports of prophylactic use of eculizumab in aHUS pregnant KTx recipients between 1993 and 2024. 35 articles were found, of which, three fulfilled our criteria (table 1).
Discussion
Although eculizumab is considered safe during pregnancy, its use in pregnant KTx recipients is rare given the lack of relevant pharmacological data and unknown long-term effects on the offspring. We report for the first time, 8-year follow up favorable maternal and fetal outcomes and provide a literature review of similar cases. We conclude that maintenance eculizumab is a plausible option for prevention of aHUS recurrence in pregnant women who received KTx. Close monitoring of hemolytic markers and kidney function is recommended to ensure early detection and management of complications.