Pregnancy in renal transplant recipients: the Royal Free Hospital experience.
BACKGROUND
For women with end-stage renal failure of child-bearing age, renal transplantation offers a chance to start a family. Pregnancies in renal transplant recipients involve risks for graft and fetus, and need to be carefully managed.


OBJECTIVE
To identify graft, fetal and maternal outcomes in our patients, and compare our results with those of the large national transplant registries.


METHODS
Retrospective case-note review.


METHODS
We assessed the outcomes of 48 pregnancies in 24 renal transplant recipients. Obstetric data and renal parameters were examined in 27-30 pregnancies that progressed to delivery.


RESULTS
Mean time from transplantation to pregnancy was 6.5 years, with an unfavourable outcome in patients who conceived within 1 year. There was a 41% incidence of fetal growth restriction (FGR), and 33% of infants were small for gestational age. FGR was associated with maternal hypertension, a pre-pregnancy serum creatinine (SCr) >/= 133 micro mol/l (1.5 mg/dl), calcineurin inhibitors and the use of cardioselective beta blockers. Two patients with pre-pregnancy SCr > 200 micro mol/l lost their grafts within 3 years of delivery. A permanent significant decline in graft function occurred in 20%, by 6 months post delivery.


CONCLUSIONS
FGR with SGA infants occurs frequently. Atenolol should be avoided in pregnancy and Metoprolol should not be combined with calcineurin inhibitors. Pregnancy appeared to have a deleterious effect on graft function in patients with SCr > 155 micro mol (1.75 mg/dl). Patients with pre-pregnancy SCr 200 micro mol/l are at greatest risk.
Thompson
B C
BC
Centre for Nephrology and Department of Obstetrics and Gynaecology, Royal Free and University College School of Medicine, London, UK.
Kingdon
E J
EJ
Tuck
S M
SM
Fernando
O N
ON
Sweny
P
P
D000328:Adult; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001724:Birth Weight / Q000502:physiology; D003404:Creatinine / Q000097:blood; D005260:Female; D005317:Fetal Growth Retardation / Q000209:etiology; D005865:Gestational Age; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007231:Infant, Newborn; D007236:Infant, Small for Gestational Age; D007668:Kidney / Q000503:physiopathology; D007676:Kidney Failure, Chronic / Q000503:physiopathology / Q000601:surgery*; D016030:Kidney Transplantation; D011225:Pre-Eclampsia / Q000209:etiology; D011247:Pregnancy; D011256:Pregnancy Outcome; D012189:Retrospective Studies; D013997:Time Factors; D017211:Treatment Failure
D000959:Antihypertensive Agents; D007166:Immunosuppressive Agents; D003404:Creatinine