Caring for the pregnant kidney transplant recipient

Abstract

As fertility can be restored to normal soon after a kidney transplant, it is important for physicians caring for recipients to be able to inform the patient about the potential risks of pregnancy. Current opinion is that pregnancy can be successful if carried out under optimal circumstances, including stable allograft function for at least one yr post-transplant without rejection, good control of blood pressure, and appropriate adjustment of immunosuppression and other known teratogenic medications prior to conception. In planning for pregnancy, one should discuss pregnancy outcomes and risks to both the mother and fetus. During pregnancy, it is important to pay close attention to medical complications such as worsening of hypertension and development of preeclampsia; risk of infection, in particular of the urinary tract; and worsening anemia. Pregnant recipients should be managed in close conjunction with a high-risk obstetrician.

Immunophenotypic Profile and Increased Risk of Hospital Admission for Infection in Infants Born to Female Kidney Transplant Recipients

“…After many days of hospitalization, one had blood culture for Burkolderia cepacia, one blood culture for Klebsiella pneumoniae ESBL and one urine culture for Enterobacter sp, Three weeks before labor. 4 Among those women, nine also had chronic hypertension and two had HELLP syndrome.…”

“…Pregnancy in these women has become possible and children born to female kidney recipients are increasingly more frequent (4,5). Most research on this population has focused attention on prematurity and low birth weight, which are often observed among children born to female kidney recipients (6,7).…”

Pregnancy After Kidney Transplantation: A Single-Center Experience and Review of the Literature

“…Table 1 presents patients' characteristics before conception; 76% of patients suffered from arterial hypertension and 6% had low-grade proteinuria (<1 g/24 h). Immunosuppressive protocols before conception consisted of: prednisone (P)/cyclosporine (CsA)/azathioprine (Aza) (8), P/CsA (6), P/Aza (2), P/tacrolimus (Tac)/mycophenolate mofetil (MMF) (3), P/Tac/Aza (2), and Tac/sirolimus (Rapa) (1). Protocols were sustained during 17/22 pregnancies and changed during 5/22 pregnancies: MMF was either converted to Aza or discontinued.…”

“…In the present single-center retrospective study of 32 years, we focused on the outcome for mother and child and compared those outcomes with registry data. We also evaluated our data in the light of current recommendations of care for the pregnant kidney transplant recipient [2].…”

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“…4 The risk of rejection with the invention of modern immunosuppression has been reduced significantly, resulting in an increasing number of women of reproductive age with good functioning grafts. 5,6 Ovulation may start as soon as 1 month after transplant; therefore, it is crucial to plan for a timely, safe conception and effective maternity care. [6][7][8] In 2010, the National Transplantation Pregnancy Registry, founded in 1991 in the United States, reported a 52.4-month mean time from transplant to conception.…”