Pregnancy in renal transplantation: Recipient and donor aspects in the Arab world

Abstract

ObjectiveThere are many kidney transplant recipients and living donors of reproductive age, and the prevalence of pregnancies in kidney transplant recipients can reach 55% in the Middle Eastern countries. Living kidney donation is predominant in this region. As the risks and outcomes of pregnancy should be a part of counselling for both recipients and donors, we reviewed available reports on maternal and foetal outcomes in these particular populations.MethodsInformation was obtained from retrospective analyses of a large database, and from single-centre reports indexed in PubMed on pregnancy in donors and kidney transplant recipients. The keywords used for the search included ‘fertility’, ‘kidney disease’, ‘pregnancy’, ‘maternal/foetal outcomes’, ‘kidney transplant recipient’, ‘immunosuppression side-effects’, ‘living donor’ and ‘Arab countries’.ResultsPregnancies in kidney transplant recipients are most successful in those with adequate kidney function and controlled comorbidities. Similarly to other regions, pregnant recipients in the Middle East had a higher risk of pre-eclampsia (26%) and gestational diabetes (7%) than in the general population. Caesarean section was quite common, with an incidence rate of 61%, and the incidence of pre-term birth reached 46%.ConclusionsMost living donors can have successful pregnancies and should not be routinely discouraged. Women who had pregnancies before and after donation were more likely to have adverse maternal outcomes (gestational diabetes, hypertension, proteinuria, and pre-eclampsia) in the latter, but no adverse foetal outcomes were found after donation. The evaluation before donation should include a gestational history and counselling about the potential risks.

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

“…The profile of the “ideal” candidate for pregnancy after transplantation is well defined: a young, nonobese, normotensive woman, with normal kidney function, in the absence of proteinuria, without any rejection episode, or at least any recent rejection episode, with good compliance, and at least two years from transplantation [ 133 , 134 , 140 , 141 , 142 , 143 , 144 ]. However, a univocal definition of age, kidney function, and interval after the last rejection episode is missing, and the grading of the risks is not clear, in particular in women with signs of kidney function impairment.…”

“…This “ideal” situation is indeed not always the rule, in particular in deceased donor transplantation. In fact, expanded donor policies may lead to suboptimal kidney function; higher age at transplantation and reduced fertility are not infrequent; conversely, the good results of pregnancy after kidney transplantation are somehow smoothing the contraindications, with a widespread agreement on a shorter stabilization time, and a permissive attitude towards pregnancy with less-than-optimal kidney function [ 133 , 134 , 135 , 136 , 137 , 138 , 139 , 140 , 141 , 142 , 143 , 144 ].…”

“…Pregnancy represents an immunologic challenge and is a potential cause of hyperimmunization, a well-known problem for transplantation. Living unrelated grafts increasingly offer a clinical solution within couples: the eventual role of pregnancy as an immunologic trigger leading to rejection of the grafted kidney should be clarified to optimize the outcomes of transplantation between husband and wife [ 142 ].…”

Pregnancy Outcomes After Renal Transplantation: A Retrospective Case Series

“…Severe pre-eclampsia affected postnatal renal function, and two patients lost their grafts at 2 and 6 years after delivery, respectively; moreover, the incidence of pre-eclampsia was higher than reported in previous studies. [1][2][3][4][5][6] From the largest registers, the incidence of hypertension during pregnancy has varied between 58% and 72% in all kidney posttransplantation pregnancies. 4 Ghafari and Sanadgol 5 reported an incidence of 40%.…”