title: Pregnancy after kidney and kidney-pancreas transplantation under tacrolimus: a single center's experience.
abstract: BACKGROUND
  Chronic renal failure leads to amenorrhea, and successful pregnancy is rare. The aim of the present report is to examine the outcome of pregnancies under tacrolimus after kidney transplantation (KTx) and simultaneous kidney-pancreas transplantation (SPKTx).
  
  
  METHODS
  All pregnancies under tacrolimus after KTx or SPKTx from 1993 to April 2002 were retrospectively examined. Renal function and the mother's survival were followed until December 2002.
  
  
  RESULTS
  Thirteen mothers after KTx delivered 19 babies, and 2 mothers after SPKTx delivered 3 babies. All mothers survived the pregnancy and retained allograft function. One mother had a stillborn baby from an unrecognized amniotic fluid leak and a small ischemic placenta. The mean gestational period was 34.4 +/- 5.1 weeks. Mean birth weight was 2373 +/- 1001 g. Birth-weight percentile to gestational period was 40 +/- 28. None of the mothers experienced rejection during the pregnancy. Three pregnancies in mothers with KTx experienced toxemia of pregnancy, and one mother with SPKTx developed pre-eclampsia during both pregnancies. Five mothers (6 deliveries, 27.3%) required caesarian section. During the follow-up period, one mother died from a cerebrovascular accident. Another five mothers returned to dialysis 55.6 +/- 32.4 months after the last delivery and 99.4+28.5 months after the last KTx. Both SPKTx mothers have maintained normal renal and pancreatic allograft function 42 and 62 months postdelivery.
  
  
  CONCLUSIONS
  All mothers survived the pregnancy. One baby was stillborn. Forty-one percent of babies were either preterm or premature, and 27% of babies were delivered by caesarean section. Toxemia of pregnancy or pre-eclampsia was observed in 23% of pregnancies postKTx and SPKTx. None of the mothers experienced rejection during their pregnancy.
authors.affiliation: Thomas E. Starzl Transplantation Institute, UPMC Montefiore, Pittsburgh, PA, USA. Ashok_Jain@urmc.rochester.ca
authors.forename: Ashokkumar B
authors.initials: AB
authors.lastname: Jain
authors.forename: Ron
authors.initials: R
authors.lastname: Shapiro
authors.forename: Velma P
authors.initials: VP
authors.lastname: Scantlebury
authors.forename: Santosh
authors.initials: S
authors.lastname: Potdar
authors.forename: Mark L
authors.initials: ML
authors.lastname: Jordan
authors.forename: Jareen
authors.initials: J
authors.lastname: Flohr
authors.forename: Amadeo
authors.initials: A
authors.lastname: Marcos
authors.forename: John J
authors.initials: JJ
authors.lastname: Fung
mesh_terms: D001724:Birth Weight; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007231:Infant, Newborn; D007677:Kidney Function Tests; D016030:Kidney Transplantation / Q000276:immunology / Q000502:physiology*; D008297:Male; D016035:Pancreas Transplantation / Q000276:immunology / Q000502:physiology*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology*; D011256:Pregnancy Outcome; D012189:Retrospective Studies; D016559:Tacrolimus / Q000627:therapeutic use*
chemical_list: D007166:Immunosuppressive Agents; D016559:Tacrolimus