Pregnancy after renal transplantation: Effects on mother, child, and renal graft function

Abstract

The aim of this study was to report our experience of pregnancy in renal transplant (RT) patients and its medium and long-term effects on the renal graft as well as the maternal fetal complications. We studied 21 pregnancies in 12 RT patients with mean age of 29.9 ± 5.3 years. The mean duration of RT to 1 st pregnancy was 42 (21-68.5) months and the median follow-up period was 112.5 (138-165) months. The pregnancy was planned in 28.6% of the cases. At the time of the diagnosis of the pregnancy, all the patients were maintained on corticosteroids and cyclosporine, 14.3% of the patients were on mycophenolate mofetil, and 71.4% of the patients were on azathioprine. The high blood pressure was present before the pregnancy in 33.3% of the patients. During pregnancy, proteinuria appeared in 20% of the cases, urinary tract infection in 33.3%, and preeclampsia in 5%. Anemia was present in all the patients during pregnancy. The doses of cyclosporine were increased during pregnancy. The mean term of delivery was 37 ± 2 weeks. Premature delivery was observed in 19% of the cases, fetal death in utero in 10%, and abortion in 15%. The number of living children was 16, with a mean birth weight of 3014 ± 515 g; the weight was lower than 2500 g in three (15%) cases. In the long-term follow-up, we noticed two cases of acute rejection related to patients' noncompliance, and four cases of chronic allograft nephropathy, without a switch to dialysis. We conclude that pregnancy in RT patients requires multidisciplinary care because of the increased risks of maternal and fetal complications. Each pregnancy needs to be planned; all parameters have to be studied and evaluated in order to allow for optimization of outcome and minimization of complications.

Pregnancy in Chronic Kidney Disease: Need for Higher Awareness. A Pragmatic Review Focused on What Could Be Improved in the Different CKD Stages and Phases

“…In particular in western countries, where age of the transplant recipients is often older, assisted fertilization is increasingly popular. Besides the ethical challenges, whose discussion is beyond the scope of this review, assisted fertilization techniques, in particular those in vitro, are associated with an increase of pregnancy complications and of hypertensive disorders of pregnancy, with a potential negative effect on the kidney function [ 152 , 153 , 154 , 155 , 156 ]. The scattered data on assisted fertilization in kidney transplant recipients are, however, encouraging; once more, the series are very small, most of them regarding single cases, and, in such a context, it is highly probable that reports are influenced by a publication bias [ 152 , 153 , 154 , 155 , 156 ].…”

Embarazo y trasplante renal. Una revisión sistemática

“…Características de los estudios Entre los 18 artículos que fueron seleccionados para la realización de esta revisión, 9 estudios fueron de Europa, 3 de América del Norte, 2 de América del Sur, 2 de Cuatro de los artículos que hacen referencia al tipo de donante, destacan que casi la totalidad de la población de estudio ha recibido el órgano de un donante vivo [26][27][28][29] . Sólo un artículo estudia a mujeres con TR de donante cadáver 23 .…”

“…Otra complicación presente en las mujeres receptoras de TR es la diabetes gestacional, aunque en los artículos revisados el riesgo de desarrollarla es bajo en comparación con el resto de complicaciones maternas 24,27,29,[31][32][33]35,38 .…”

“…Respecto a los parámetros bioquímicos, desde el inicio hasta el tercer trimestre de embarazo se produce un aumento significativo del nivel de creatinina sérica en la población 26,27,29,32,39 .…”

Outcome of pregnancy after renal transplantation

“…However, in 2016, El Houssni et al 13 found much better outcomes of pregnancy after renal transplantation. That study included 21 pregnancies in 12 women who had undergone renal transplantation, with a mean interval between transplantation and pregnancy of 3 years and 6 months; 7 pregnancies had occurred within 2 years of transplantation.…”