Pregnancy after Renal Transplantation

Hur, C Y; Yoon, B H; Kwon, J H; Jun, J K; Syn, H C

Abstract

BACKGROUND: Renal transplantation remains the best form of treatment for women with end-stage renal failure who wish to have children. Successful pregnancies have been reported after transplantation, but they are often associated with increased fetal and maternal risks. Therefore data about the outcome of pregnancy in renal transplant recipients should be available to facilitate the decision making process.
OBJECTIVE
To study the outcome of pregnancy in renal transplant recipients. STUDY DESIGN: A retrospective review. SUBJECTS: Pregnant women beyond the period of third trimester who had renal transplantation between 1969 and 1996.
RESULTS
There was a total of 10 patients and 12 pregnancies and 13 offsprings. One patient had a twin pregnancy and two patients had 2 pregnancies after renal transplantation. All patients continued their immunosuppressive regimens during the entire pregnancy. The mean interval from the time of transplantation to conception was 46.6 months(range, 11 to 97 months). There were complications of 3 cases of hypertension and 2 cases of acute rejection before conception. All had normal prior values of serum creatinine before conception(range, 0.8 to 1.2 mg/dl) except three patients whose serum creatinine values before conception were not available. The mean gestational age at delivery was 37(+5) weeks(range, 32(+6) to 41(+1) weeks) with an incidence of prematurity(gestation <37 weeks) of 50%, and their offspring weighed from 1.46 kg to 3.13 kg(mean, 2.46 kg), presenting a high incidence of low birthweight(46.2%). There was one stillborn who had congenital anomaly of anencephaly. The obstetric complications were distributed as follows: premature rupture of membranes in 2 cases(16.7%), preterm labor in 2 cases(16.7%), pregnancy induced hypertension in 2 cases(16.7%), pregnancy aggravated hypertension in 1 case(8.3%), and intrauterine growth restriction detected before delivery in 1 case (8.3%). Cesarean section was necessary in 1 of 12 cases(8.3%). Neonatal complication was found in one case, pnuemonia. No patient had any rejection episode or graft loss during pregnancy, but 5 cases had experienced chronic renal rejection after delivery(range, 3 to 18 months).
CONCLUSION
Women with a renal transplant can have a successful pregnancy, but there are definite risks for both mother and fetus. Pregnancy should be discussed with the woman wish ing to have pregnancy and encouraged only if there is good renal graft function.