An etiologic classification was performed in 327 patients with recurrent spontaneous abortion at the Department of Obstetrics and Gynecology, Hanyang University Hospital from May 1990 through July 1992. Of those, 30 patients were classified as
alloimmune etiology. Among them, 22 patients were immunized with paternal (N=11) or third-party donor (N=11) leukocytes and the efficacy of immunization was evaluated, respectively.
@ES The results of immunotherapy were as follows:
@EN 1. Immunologic causes revealed 26.0% (85 among 327 patients) regardless combination with other etiologies. On the subclassification of the immunologic causes regardless combination, autoimmune etiologies were 61 cases and alloimmune
etiologies
were
30 cases. Combined autoimmune and alloimmune etiologies were 6 cases.
2. HLA typing was studied in 10 couples. Among them, 7 couples shared 2 or more HLA antigens (70%), 1 couple shared 1 HLA antigen. There were 2 couples who had no HLA sharing.
3. The rate of seroconversion of Blocking effect index (BEI) in patients who were immunized with paternal leukocytes was 42.9% (3 cases among 7 cases which checked BEI at pre- and post-immunization). There were 2 cases of increased BEI but below
20%,
and 2 cases of decreased BEI after immunization.
4. The rate of seroconversion of BEI in patients who were immunized with third-party donor leukocytes was 50% (4/8). There were a cases of increased BEI but below 20%, and 2 cases of decreased BEI after immunization.
5. The success rate was 75% in patients who were immunized with paternal leukocytes (6 cases among 8 cases which pregnancy outcome were established), and 83.3% in patients who were immunized with third-party donor leukocytes (5/6). The overall
success
rate was 78.6% (11/14).
Although still experimental, the results showed that immunotherapy appe3ars to be a recommendable therapy for couples with alloimmune etiologic recurrent spontaneous abortion. The immunization with third-party donor leukocytes also revealed
favorable
pregnancy outcome and it is recommendable if paternal leukocytes were not available due to risk of viral transmission, maternal sensitization to HLA, erythrocytes or platelet antigens, and the possibility of graft-versus-host disease.
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