Successful Pregnancy After Combined Renal-Pancreas Transplantation: A Case Report and Literature Review

Abstract

A long-standing history of insulin-dependent diabetes mellitus can result in multiple organ damage. We present a case of successful pregnancy in a patient who underwent combined renal-pancreas transplantation for end-stage renal disease due to diabetic nephropathy. A 29-year-old white gravida 7, para 2 female was diagnosed with diabetes mellitus at age 7. She was well controlled with insulin until age 21. She developed complications of diabetes mellitus which included retinopathy resulting in legal blindness, nephropathy resulting in end-stage renal disease, and chronic hypertension. Following nine months of dialysis she underwent a combined renal-pancreas transplant. She subsequently became pregnant 21 months after transplantation and delivered a healthy male at 35 1/2 weeks gestation. Renal-pancreas transplant recipients who become pregnant may be at an increased risk for adverse outcome. We present a successful pregnancy outcome in a combined transplant recipient who had a prior poor obstetrical history.

Pregnancy after kidney and kidney-pancreas transplantation under tacrolimus: a single center’s experience

“…The impact of pregnancy on graft loss is difficult to evaluate, but the high rate of graft loss is clearly of concern. This observation is also different than what is observed in pregnancies after liver transplantation under tacrolimus (10,11).…”

“…DISCUSSION In the past, we reported the largest single-center experience of pregnancy after liver transplantation under tacrolimus, with satisfactory outcomes, which has been confirmed by others (8,9). Either small case studies or review articles are available on pregnancy after SPKTx (10,11).…”

A best-practice position statement on pregnancy after kidney transplantation: focusing on the unsolved questions. The Kidney and Pregnancy Study Group of the Italian Society of Nephrology

“…The best contraception treatment is still a matter of debate and a further best-practice paper will be dedicated to this issue. In the lack of evidence, the Study Group suggests a tailored approach be adopted, taking age, kidney function, risk of infection, renal disease and coagulation derangements into account [ 128 , 199 – 203 ].…”

Vaginal delivery following combined pelvic renal and pancreatic transplant

“…Since 1986 when the first successful pregnancy following pancreatic transplantation was described 1 there have been approximately 20 cases 2–9 reported in the world literature. Transplantation of the pancreas is an accepted treatment for insulin‐dependant diabetes mellitus and is commonly combined with renal transplantation for chronic renal failure secondary to diabetic nephropathy.…”