Twin pregnancy after kidney transplantation: case report and systematic review

Abstract

Background: Kidney transplantation is associated with fertility restoration in more than 50% of women with chronic kidney disease. Pregnancy after transplantation may affect women’s health and fetal development, with higher rates of abortion, fetal growth restriction, and neonatal deaths. Twin pregnancy is a condition of high-risk for adverse maternal and perinatal outcomes, and its occurrence in women with previous kidney transplantation is rare. Case: 32-year-old woman, recipient of living donor kidney transplantation, with a history of one pregnancy prior to transplantation, with current normal allograft function and no use of contraceptive method. At ten weeks of amenorrhea, ultrasound investigation showed a dichorionic diamniotic twin pregnancy. The following evaluation showed Chiari type II features in one fetus, and no detectable abnormality in the other one. There was appropriate blood pressure control with no need for an antihypertensive drug, and renal function remained normal without proteinuria. Calcium and a low dose of acetylsalicylic acid were used as preeclampsia prophylaxis. At 33 weeks of gestation, she presented premature rupture of membranes with spontaneous preterm labor. A cesarean section was performed due to the breech presentation of the first fetus. The patient persisted with normal graft function and without graft rejection during follow-up. Discussion and conclusion: Twin pregnancies after kidney transplantation are rare, and it is most frequently associated with preterm birth. We reported a successful twin pregnancy after kidney transplantation, with good perinatal and maternal outcomes, and without graft rejection or dysfunction.

Successful twin pregnancy in a woman undergoing alternate diurnal and nocturnal hemodialysis

“…We describe the case of a twin pregnancy in a woman undergoing hemodialysis, which is rarely reported in the literature (it is also a rare event in kidney transplantation 1 ). In 2018, Alix et al reported the birth of twins in a woman undergoing hemodialysis who had three previous pregancies 2 .…”

Correlation between Parturients’ Uterine Artery Blood Flow Spectra in the First and Second Trimesters of Pregnancy and Fetal Growth Restriction

“…General information: the general information extract forms were established by the parturients themselves, covering inpatient number, name, age, gestational weeks, gravidity, parity, newborn body weight, Apgar scores [ 17 ], number of preterm infants, number of infants transferring to the neonatal intensive care unit (NICU), and place of residence, monthly income, and educational degree of the parturients…”

“…(1) General information: the general information extract forms were established by the parturients themselves, covering inpatient number, name, age, gestational weeks, gravidity, parity, newborn body weight, Apgar scores [17], number of preterm infants, number of infants transferring to the neonatal intensive care unit (NICU), and place of residence, monthly income, and educational degree of the parturients (2) Blood flow spectra in the first and second trimesters of pregnancy: in the two periods, the UtA-PI, UtA-RI, and UtA-S/D indicators of the parturients in the two groups were compared (3) Incidence rates of early diastolic notch of the uterine artery: the incidence rates of early diastolic notch of the parturients in the two groups were calculated (4) Association between uterine artery blood flow spectra in the first and second trimesters of pregnancy and FGR: the association between UtA-PI, UtA-RI, and UtA-S/D in the two periods and FGR was analyzed with the ROC curve 2.8. Statistical Processing.…”

Azathioprine associated with intrahepatic cholestasis in a patient with twin pregnancy after a second kidney transplant

“…Other complications include hypertension, deterioration of graft function, urinary tract infections and the possibility of transplant rejection. Twin pregnancy after a renal transplant is rare with high risk of adverse maternal and foetal outcomes [3] . Among the immunosuppression medications for kidney transplantation, short-acting glucocorticoids, azathioprine and calcineurin inhibitors are considered relatively safe for the risk of major congenital malformations during pregnancy.…”