World journal of transplantation · 2026
Successful term pregnancy after renal transplant in end-stage renal disease with complement factor H-related mutation: A case report.
Клинический случайСтатьяНазвание и аннотация: Перевод в очереди
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Balwani Manish Ramesh, Pasari Amit, Kashiv Pranjal, Shembekar Chaitanya, Shembekar Manisha, Dubey Shubham, Jeyachandran Vijay, Malde Sunny, Gupta Sushrut, Pawar Twinkle, Tolani Priyanka, Kurundwadkar Mohit, Gurjar Prasad, Sejpal Kapil, Bawankule Charulata, Kute Vivek B
Аннотация
BACKGROUND: Complement-mediated thrombotic microangiopathy (TMA) is a rare endothelial injury syndrome caused by dysregulated activation of the alternative complement pathway, often linked to genetic abnormalities in complement factor H (CFH), complement factor I, or complement factor H-related (CFHR) proteins. Both renal transplantation and pregnancy are independent triggers for recurrence. This case highlights a genetically high-risk patient who achieved a successful term pregnancy after renal transplantation without complement inhibition, emphasizing individualized risk stratification, close surveillance, and multidisciplinary management for favourable maternal and graft outcomes.
CASE SUMMARY: A 32-year-old woman with end-stage renal disease secondary to genetically confirmed complement-mediated TMA-homozygous CFH exon 17 deletion and CFHR3-CFHR1 duplication-was maintained on dialysis for 2.5 years before undergoing a successful live-donor kidney transplant from her mother. Post-transplant immunosuppression included tacrolimus, mycophenolate mofetil, and prednisolone, later modified to azathioprine during pregnancy planning. One-year post-transplant, she conceived spontaneously. Pregnancy was complicated by transient gestational hypertension, controlled with nifedipine, labetalol, and amlodipine. Proteinuria remained < 150 mg/day; white blood cell counts 5.8-7.2 × 109/L without cytopenia. Serum creatinine ranged 0.9-1.1 mg/dL, and tacrolimus trough levels 5-7 ng/mL. At 36 weeks, she delivered a healthy 3 kg infant by elective caesarean section. Postpartum follow-up at three months confirmed stable maternal and graft function.
CONCLUSION: High-risk complement-mediated TMA patients can achieve successful pregnancy post-transplant through individualized care without mandatory complement blockade.
CASE SUMMARY: A 32-year-old woman with end-stage renal disease secondary to genetically confirmed complement-mediated TMA-homozygous CFH exon 17 deletion and CFHR3-CFHR1 duplication-was maintained on dialysis for 2.5 years before undergoing a successful live-donor kidney transplant from her mother. Post-transplant immunosuppression included tacrolimus, mycophenolate mofetil, and prednisolone, later modified to azathioprine during pregnancy planning. One-year post-transplant, she conceived spontaneously. Pregnancy was complicated by transient gestational hypertension, controlled with nifedipine, labetalol, and amlodipine. Proteinuria remained < 150 mg/day; white blood cell counts 5.8-7.2 × 109/L without cytopenia. Serum creatinine ranged 0.9-1.1 mg/dL, and tacrolimus trough levels 5-7 ng/mL. At 36 weeks, she delivered a healthy 3 kg infant by elective caesarean section. Postpartum follow-up at three months confirmed stable maternal and graft function.
CONCLUSION: High-risk complement-mediated TMA patients can achieve successful pregnancy post-transplant through individualized care without mandatory complement blockade.