We 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.
These 2 reports2 show the relevance of the issue of conception in transplanted women with atypical hemolytic uremic syndrome while undergoing C5-inhibitor therapy. Moreover, it gives guidelines on the management of these high-risk pregnancies. In both cases, the preemptive increase in eculizumab dosage permitted an efficient complement blockage throughout pregnancy, allowing the prevention of atypical hemolytic uremic syndrome flare.
Although these preliminary data seem promising concerning graft, maternal, and fetal outcomes, it is important to highlight the lack of pharmacologic data on eculizumab therapy in transplanted pregnant women and the absence of current knowledge on the potential long-term impact of this therapy in children. Hence, prenatal counseling and pre- and postpartum close specialized follow-up of both mother and child are critical.
References
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