[Experience of 28 deliveries in 21 kidney transplant recipients].
BACKGROUND
Risk factors to induce graft dysfunction during pregnancy in kidney transplant recipients were studied.


METHODS
A total of 28 deliveries from 21 female kidney transplant recipients were analyzed.


RESULTS
All recipients were maintained on either azathioprine-based (n = 17) or cyclosporine-based (n = 11) immunosuppressive regimens. Graft dysfunction (creatinine clearance < 40 ml/min) occurred in 8 cases (8 patients) during pregnancy. No acute rejection, however, could be observed. In a case-controlled study comparing a group with graft dysfunction vs. a group with good graft function, there were significantly differences in the incidence of the cases with pre-existing hypertension (62.5% vs. 10.0%), the age of the grafted kidney (58.1 vs 47.6 year), the maternal anemia (Hb: 10.3 vs. 11.8 g/dl) and the creatinine level (1.4 vs. 1.0 mg/dl) at the first trimester. These findings suggested that poorer graft function had been underlying before pregnancy and that additional loading of the pregnancy reduced further graft function, while the deterioration would be recovered after delivery in all cases except one case.


CONCLUSIONS
Risk factors to induce graft dysfunction during pregnancy are as follows. 1) high age of the grafted kidney (> 50 year), 2) pre-existing hypertension, 3) maternal anemia (Hb: < 11 g/dl) and 4) high creatinine level (> 1.3 mg/dl) at the first trimester.
Nagano
S
S
Department of Urology, Kidney Transplantation Center, Hyogo Prefectural.
Kyo
M
M
Hanafusa
T
T
Ichikawa
Y
Y
Fukunishi
T
T
Ito
K
K
Nojima
M
M
Fujimoto
N
N
D000328:Adult; D001379:Azathioprine / Q000008:administration & dosage; D016572:Cyclosporine / Q000008:administration & dosage; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D007668:Kidney / Q000503:physiopathology; D016030:Kidney Transplantation; D007743:Labor, Obstetric; D011247:Pregnancy; D011248:Pregnancy Complications; D011256:Pregnancy Outcome
D007166:Immunosuppressive Agents; D016572:Cyclosporine; D001379:Azathioprine