Graft-versus-host disease and immunologic rejection: implications for diagnosis and treatments of pregnancy complications

摘要

This paper summarizes recent evidence from transplantation, autoimmune and obstetrical literatures, suggesting that exposure to (allogeneic) donor cell traffic may be prerequisite for successful tolerance of allogeneic grafts in organ transplantation and pregnancy, where the fetus represents a semiallogeneic graft. It is based on a review of the literature utilizing PubMed and Medline searches. Donor cells can induce adverse effects, including graft-versushost disease, acute and/or chronic graft rejection and/or related autoimmune phenomena. Observations in the pre-eclampsia/eclampsia syndrome suggest that some still largely unexplained conditions of pregnancy, possibly including labor, may represent acute graftversus-host disease states. Abnormal clinical and laboratory responses may be the consequence of excessive histocompatibility (HLA) antigen dosaging, due to excessive fetal–maternal cell traffic. On other occasions, antigen dosaging may be appropriate, but maternal/paternal HLA may be too similar. Studies in habitually aborting patients have indicated that underexposure to HLA may induce (auto)immune abnormalities. All of these observations suggest that in a number of currently still poorly understood obstetrical conditions, immunologic treatment options deserve further careful investigation.