Pregnancy After Kidney Transplantation: Two Transplantation Centers—Vicenza–Udine Experience

• Published in: Transplantation proceedings Vol. 42; no. 4; pp. 1158 - 1161
• Main Authors: Di Loreto, P, Martino, F, Chiaramonte, S, Dissegna, D, Ronco, C, Marchesoni, D, Catapano, P, Romano, G, Montanaro, D
• Format: Journal Article Conference Proceeding
• Language: English
• Published: Amsterdam Elsevier Inc 01-05-2010; Elsevier
• Subjects: Apgar Score; Biological and medical sciences; Breast Feeding - adverse effects; Cesarean Section; Female; Fetal Diseases - epidemiology; Fetal Growth Retardation; Fundamental and applied biological sciences. Psychology; Fundamental immunology; Humans; Immunosuppressive Agents - adverse effects; Immunosuppressive Agents - therapeutic use; Infant, Newborn; Kidney Transplantation - immunology; Kidney Transplantation - pathology; Kidney Transplantation - physiology; Medical sciences; Pre-Eclampsia - epidemiology; Pregnancy; Pregnancy Complications - epidemiology; Pregnancy Outcome - epidemiology; Puerperal Disorders - epidemiology; Respiratory Distress Syndrome, Adult; Retrospective Studies; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the urinary system; Tissue, organ and graft immunology; Treatment Failure; Treatment Outcome; Human; Center; Homotransplantation; Kidney; Pregnancy; Medicine; Experience; Treatment; Urinary system; Surgery; Female; Graft; Woman; Kidney transplantation
• ISSN: 0041-1345; 1873-2623
• DOI: 10.1016/j.transproceed.2010.03.082

Abstract Background Pregnancy after kidney transplant has become possible thanks to the recent surgical and pharmacological breakthrough. Materials and Methods We performed a restrospective study including all childbearing women transplanted in our centers after 1997. The following variables were analyzed: type of nephropathy, patient age when dialysis started, age at transplantation, time between dialysis and transplantation and between transplantation and baby birth. We also considered immunosuppressive therapy, type of delivery, baby weight, Apgar score, and mother and baby follow-up. Results We followed up 13 pregnancies in 12 patients who were diagnosed with chronic pyelonephritys (n = 4), postpartum cortical necrosis (n = 1), immunoglobulin A GN (n = 4), diabetic nephropathy (n = 1), unknown nephropathy (n = 2). All patients received a cadaveric donor kidney. They were treated with calcium antagonists and alfamethyldopa for their high blood pressure. We observed 9 mother complications: nonnephrotic proteinuria (n = 1), urinary tract Infection (n = 1), pre-eclampsia (n = 4), internal placenta detachment (n = 1) and spontaneous abortions (n = 2); 4 fetal complications: IUGR (n = 2), acute distress respiaratory syndrome (n = 1), Klinefelter syndrome (n = 1) and preterm births (n = 4). In 2 cases the child weight was lower when compared to the gestational age, and 5 babies were admitted to the neonatal intensive care unit. The mother's follow-up showed no acute rejection episodes. Breastfeeding was discouraged due to the transmission of immunosuppressive medications into breast milk. We did not observe significant disease upon child follow-up. Conclusion Our data were in agreement with the literature confirming that pregnancy after kidney transplant though possible carries elevated risks. Patients therefore are referred to highly specialized centers where obstetricians, nephrologists, intensivists, and neonatologists provide surveillance and treatment.