Fertility is restored in women undergoing kidney transplantation after recovery of renal function and successful pregnancy has been reported. Objective: evaluate the gestations of transplant patients, analyzing outcomes and complications as well as long term evolution of renal function.
We performed a retrospective study investigating the outcome of 101 pregnancies in 89 renal transplant recipients. The following variables were analyzed: Type of nephropathy, patient age when dialysis started, at transplantation, at pregnancy, time between dialysis and transplantation, and between transplantation and baby birth. Immunosuppressive therapy, type of delivery, baby weight, Apgar score and mother and baby follow up were also considerate.
In 9 patients were diagnosed Chronic Pyelonephritis, Post Partum Cortical Necrosis (1 pt), IgA GN (11 pt), Diabetic Nephropathy (5 pt), Unknown Nephropathy (23 pt), ADPKD 1, Nephroangiosclerosis 5 pt, Glomerulonephritis 26 pt, Cistic Kidney disease 2 pt, Nephronoptsis 1 pt, Tubulo interstizial Nephropathy 1 pt, Obstructive Nephropathy 2 pt, Alport Syndrome 1 pt, Renal displasia 1 pt (FIG 1) The patients’ age at start of hemodialysis (3 times/week) was 28,05±2,35 years, the patients’ age at transplantation was 30,25±2,52 years, the patients’ age at pregnancy was 33,9±3,1 years, the interval between the start of hemodialisys and transplantation was 16±22,3 months, the time between transplantation and childbirth was 4,45±3,15 years. Immunosuppressive therapy included Prednisone, Azathioprine and CyA in 39 pt, Prednisone and Tacrolimus in 1 pt, Prednisone e CyA in 16 pt, Aza e Prednisone in 3 pt, Prednisone, Aza, CyA, Fk in 1 pt, Aza, Prednisone, Fk in 5 pt, Cya (2pt), 5 FK (5pt), Aza(1pt) e CyA 7 pt. (fig 2).The renal function was normal before (serum creatinine 1,1±0,115 mg/dL), during (0,9±0,10 mg/dL) and after pregnancy (1,09± 0,125 mg/dL) .The mode of delivery was Caesarean section in 99% cases, 1% vaginal delivery. The mothers’ complications during pregnancy (Fig 3) were: Non Nephrotic Proteinuria (n=6), Urinary Tract Infection (n=4), Preeclampsia (n=4), Internal Placenta Detachment (n=1), Spontaneous Abortion (n=26), High Blood Pressure (n= 14), Acute rejection (n= 3), Others (n=2). During the mother’s follow up there was no acute rejection episode. Currently all patients show good renal function (serum creatinine 1,09±0,25 mg/dl) We observed 35 term births, 60 preterm births with 26 cases of child weight at birth lower than expected by the gestational age. The mean gestational age was 35,4±3,15 weeks, the birth weight was 2350±890 grams, the Apgar score between 4/8 and 6/9. Five babies were admitted to the neonatal intensive care unit. (Fig 4) The fetal complications (Fig 5) included: IUGR (n= 2), Acute Distress Respiratory Syndrome (n=2), Klinefelter Syndrome (n=1). Breastfeeding was discouraged due to the transmission of the immunosuppressive medications into breast milk. We did not observe any significant disease in child’s follow up.
The majority of pregnancies in renal transplant recipients have a good outcome, but with increased incidence of preeclampsia, reduced gestational age, and low birth weights confirming that pregnancy after kidney transplant, though possible, carries an elevated risk and patients therefore to be referred to highly specialized centres where nephrologists, obstetricians, intensivists and neonatologists providing surveillance and treatment.