Pregnancy after Kidney Transplantation

Abstract

Reproductive success is a common, expected outcome for male and female recipients of solid-organ transplants. Men can father children, and women can become pregnant and carry the fetus to delivery. There are, however, important maternal and fetal complications that need to be considered to provide optimal care to the mother and her infant. Although pregnancy is common after the transplantation of all solid organs, guidelines for optimal counseling and clinical management are limited. This review discusses information to help the physician counsel the kidney transplant recipient about risks of pregnancy for the mother and the fetus and provides information to help guide treatment of the pregnant transplant recipient.

The Effect of Spontaneous Twin Pregnancy on Renal Transplant Function and Haemodynamics

“…The degree of pre-existing renal impairment correlates with the risk of poor pregnancy outcome, including preeclampsia, preterm birth, small for gestational age and neonatal mortality [1,7]. Recent guidelines suggest that it is safe to proceed with pregnancy as early as 6 months following transplantation if graft function is optimal (creatinine <132 mmol/L), urinary protein excretion is minimal (<500 mg/24 h) and immunosuppression dosing is stable [4].…”

“…Higher rates of stillbirth, preterm delivery, low birth weight, pre-eclampsia, neonatal death and transplant dysfunction are reported [1]. Spontaneous twin pregnancy is uncommon in renal transplant recipients and potentially presents an even greater risk to the mother, the transplant and the fetuses [2,3].…”

Corticosteroids and Anti-Complement Therapy in Retinal Diseases

“…According to the National Transplantation Pregnancy Registry, the incidence of major malformations associated with tacrolimus use was not much higher than in the general population (McKay and Josephson 2008). However, the available data are limited, and concerns have been raised about more subtle defects that may go unrecognized at birth, such as neurocognitive deficits.…”

Topics in Transplantation Medicine for General Nephrologists

“…McKay and Josephson summarize a more intensive management strategy for patients considering pregnancy after transplantation (69). Coordination with the patient's obstetrical specialist and the transplant center will ease the management of these complicated patients during this critical period.…”