Pregnancy after lung transplantation: TRIGGER study on antihuman leukocyte antigen alloimmunization and...

Pregnancies in women with lung transplants are considered high-risk due to comorbidities. There is a risk of pregnancy-related antihuman leukocyte antigen alloimmunization, which can potentially lead to antibody-mediated rejection in transplant patients. A few such cases have been reported in women receiving kidney, liver, or heart transplants, but this risk has never been studied in lung transplantation. The aim of our study was to investigate the risk of developing antibody-mediated rejection in the year following pregnancy.

This is a multicenter retrospective study carried out in 11 French lung transplant centers. We included lung transplant recipients who had a pregnancy between January 1, 2012 and December 31, 2021.

Seventy-six pregnancies were included in 52 patients. These were mainly women with double lung transplantation (n = 43; 82.7%). Cystic fibrosis (n = 40; 76.9%) and pulmonary hypertension (n = 11; 21%) were the main underlying diseases for transplantation. Of the 76 pregnancies, 43 (56.6%) resulted in the birth of live children, while the others resulted in abortion (n = 8; 10.5%) or miscarriage (n = 25; 32.9%). Five antibody-mediated rejections (6.6%) were identified in the year following pregnancy, with a mean time of 6.24 ± 6.02 months between the end of pregnancy and rejection. All 5 rejections resulted in graft loss, of which 2 deaths and 3 retransplantations. Nineteen pregnancies (25%) resulted in alloimmunization. When antihuman leukocyte antigen antibodies were de novo donor-specific antibodies (n = 5), antibody-mediated rejection occurred in all cases.

Pregnancy in female lung transplant recipients appears to be at risk of humoral rejection in the year following pregnancy.