Neonatology Ward, 1st Department of Obstetrics and Gynecology, Medical University of Warsaw, Warsaw, Poland.
1st Department of Obstetrics and Gynecology, Medical University of Warsaw, Warsaw, Poland.
J Matern Fetal Neonatal Med. 2022 Sep;35(17):3365-3372. doi: 10.1080/14767058.2020.1818219. Epub 2020 Sep 14.
The immune status of children exposed prenatally to immunosuppressants is not fully understood.
A single-center study evaluated possible differences in antibody levels between children prenatally exposed to immunosuppressants born to mothers after hepatic or kidney transplantation (study group) compared to children without prenatal exposure to immunosuppressants (control group). Children from the study and control group were age-matched at the time of the examination and gestational age-matched, so as to obtain similar stages of the vaccination schedule and to enable reliable comparison of the results. The selection of children was made in a 1:1 ratio. The study population, a total of 138 children, was divided according to the age of the children at the time of the study into three age groups: newborns, infants (from 29 days to 1 year) and children aged >1 year. Immunoenzymatic tests were used to analyze the titers of the chickenpox virus (VZV-IgG), rubella (RuV-IgG) and hepatitis B virus (HBV, HBsAb). The studied differences were compared depending on the age group and the immunosuppressive regimen used by the pregnant mother.
In neonates born to mothers after liver transplantation, significant differences were found in HBsAb levels (>250 mIU/ml) compared to newborns without prenatal exposure to immunosuppressants taken by pregnant mothers (11/16, 69% vs. 4/14, 29%, respectively; = .028). A similar difference in the level of HbsAb was no longer noted at later stages of children's lives. In infants, these values were 80% (4/5) vs. 33% (2/6), and in children over 1 year of age 15% (7/48) vs. 12% (6/49), respectively. No other significant differences were noted when compared the distribution of measured parameters of VZV and RuV in both analyzed groups (children of mothers after kidney or liver transplantation chronically treated with immunosuppression and children without prenatal exposure to immunosuppression).
Prenatal exposure to immunosuppressive therapy does not appear to affect VZV, RuV and HBV antibody levels in children of mothers who have had a kidney or liver transplant. Initially elevated HBSAb levels in newborns of mothers after liver transplantation are not observed in later stages of life.
儿童在产前接触免疫抑制剂的免疫状态尚不完全清楚。
一项单中心研究评估了母亲在肝或肾移植后所生孩子中，产前接触免疫抑制剂的儿童（研究组）与未产前接触免疫抑制剂的儿童（对照组）之间抗体水平的可能差异。在检查时，研究组和对照组的儿童按年龄匹配，胎龄匹配，以便获得相似的疫苗接种阶段，并能够可靠地比较结果。儿童的选择以 1:1 的比例进行。共有 138 名儿童的研究人群根据研究时儿童的年龄分为三个年龄组：新生儿、婴儿（29 天至 1 岁）和>1 岁的儿童。免疫酶试验用于分析水痘病毒（VZV-IgG）、风疹病毒（RuV-IgG）和乙型肝炎病毒（HBV、HBsAb）的滴度。根据年龄组和母亲使用的免疫抑制方案比较了研究差异。
在母亲肝移植后出生的新生儿中，与母亲未产前接触免疫抑制剂的新生儿相比，HBsAb 水平（>250 mIU/ml）存在显著差异（16 例中有 11 例，69% vs. 14 例中有 4 例，29%；=0.028）。在儿童生命的后期阶段，不再注意到 HbsAb 水平的类似差异。在婴儿中，这些值分别为 80%（5 例中有 4 例）和 33%（6 例中有 2 例），在>1 岁的儿童中分别为 15%（48 例中有 7 例）和 12%（49 例中有 6 例）。当比较慢性接受免疫抑制治疗的母亲肾或肝移植后儿童与未产前接触免疫抑制剂的儿童两组之间 VZV 和 RuV 测量参数的分布时，未注意到其他显著差异。
产前接触免疫抑制疗法似乎不会影响母亲进行过肾或肝移植的儿童的 VZV、RuV 和 HBV 抗体水平。在母亲肝移植后新生儿中最初升高的 HBSAb 水平在生命后期阶段不再观察到。
