A Retrospective Analysis of Pregnancy Outcomes after Kidney Transplantation in a Single Center

Abstract

Background: We reported pregnancy outcomes after kidney transplantation in a single transplant center. Methods: We reviewed the perinatal outcomes of female kidney transplant patients of reproductive age (18-40 years) from 1987 to 2011. Results: A total of 246 patients were reviewed. Of these, 43 women registered a pregnancy following kidney transplantation. The mean patient age was 31.3 ± 4.2 years (range 24-40). The mean transplant-conception interval was 35.9 ± 12.6 months (range 24-120); 9 patients had a cadaveric allograft. The human leukocyte antigen match was ≥3/6 for 34 patients. The rate of live births was 29/43 (67.4%), miscarriage 10/43 (23.2%), preterm delivery 7/29 (24.1%), preeclampsia 5/29 (17.2%), and intrauterine growth retardation 2/29 (6.9%). Overall, 3/29 patients (10.3%) received a blood transfusion during pregnancy due to persistent symptomatic anemia, despite iron replacement and erythropoietin therapy; 24 patients (82%) had a cesarean section delivery; 3 patients had kidney rejection during pregnancy, with 2 occurring during the 6th postpartum month. Conclusion: Pregnancy should be considered a high risk in renal transplant recipients, necessitating close follow-up.

Pregnancy Among Women with Kidney Transplantation: A 20-Years Single-Center Registry

“…Spontaneous abortion is a known concern among women who use immunosuppressant therapy due to the effect of the drugs used. In our cohort, only two abortions were reported, a result similar to those of other reports, 12 13 and we had no cases of fetal malformation, probably due to the adequacy of the therapeutic scheme adopted toward women planning pregnancy. The placental concentration of cyclosporin used to be between 5 and 10 times higher than that found in maternal blood, with the fetus blood level about half than that found in the mother.…”

“…Pre-eclampsia was a common complication in our cohort, as it was in other previous reports. 12 13 17 Prescribing low-dose aspirin and calcium supplementation, with an intensive surveillance of blood pressure has been the standardized follow-up of these women in our center. Also, we believe that a frequent assessment of the renal function using serum creatinine and 24-hour proteinuria is mandatory in these cases.…”

Shearing-force injury of a kidney transplant graft during cesarean section: a case report and review of the literature

“…While several studies comment on the importance of avoiding injury to graft, no specific recommendations exist to on how to prevent this potentially devastating complication [6]. One case report describes injury to a pelvic transplanted kidney due to accidental transection.…”

“…With improved fertility in reproductive aged patients, obstetricians are seeing more solid organ transplant patients. Pregnancy carries increased risk in transplant patients, with increased incidence of pre-eclampsia, gestational diabetes, preterm delivery, fetal growth restriction, and Cesarean section [3–6]. An international meta-analysis demonstrated a 57% risk of Cesarean section in the setting of kidney transplantation, compared to the 32% national average [4].…”

Impact of pregnancy on allosensitization in women with stage 5 chronic kidney disease

“…Хотя исследований кандидатов из списка ожидания немного, одноцентровой анализ женщин и мужчин, рассматриваемых для первой трансплантации почки от живого донора, демонстрирует большие различия сенсибилизации и воздействиях между мужчинами и женщинами. Несмотря на то, что у большинства женщин с историей беременности или переливаний крови не развиваются антитела в достаточном количестве, чтобы обострить выработку PRA антител, аллоиммунизация беременностью, приводит к более широкой сенсибилизации, чем переливание компонентов крови [16].…”