title: Pregnancy in renal transplant recipients.
abstract: Fertility is restored after renal transplantation when good function is achieved. Our aim was to describe the gestations of our transplanted patients, analyzing outcomes and complications as well as long-term evolution of renal function. From 1976 to 2004, 43 gestations occurred in 35 renal transplanted women: their mean age was 31.7 +/- 4.06 years, with a mean time from the transplant to pregnancy of 4.32 years (0.4-13). At conception, all showed normal renal function (SCr 1.05 +/- 0.2 mg/dL). There were 19 abortions (43.8%), 9 of them spontaneous (21%) and 10 therapeutic (six cases for noncompliance with described criteria of European Best Practice Guidelines for Renal Transplantation, especially pregnancy less than 6 months after transplantation). Excluding these six cases of therapeutic abortions, 24 successful pregnancies occurred in 37 women (65.7%), although eight (29.1%) had premature delivery with live fetuses. Arterial hypertension was the most frequently complication (64%). Preeclampsia occurred in nine (37.5%) pregnancies, with proteinuria in five and only two with mild renal function deterioration. The majority of patients received cyclosporine (n = 20) or tacrolimus (n = 19). Since 1996, mycophenolate mofetil and sirolimus were stopped before conception. Birth weight was lower than 2500 g in 33.3% of pregnancies. Every newborn baby was healthy. Afterward, of the 24 patients with successfully pregnancy, 21 (87.5%) have functioning renal transplants at 53.2 months. After delivery, all currently show good renal function (SCr 1.16 +/- 0.35 mg/dL, CrCl 91 +/- 28.45 mL/m). In conclusion, pregnancy in our renal transplant women shows a success rate of 65.6%. However, complications related to arterial hypertension such as preeclampsia are frequent. The incidence of spontaneous abortions was similar to other series (21%). Long-term graft survival does not seem to be negatively affected by pregnancy.
authors.affiliation: Renal Transplant Unit, Nephrology Department, Hospital 12 Octubre, Madrid, Spain. mariajosegutierrezsanchez@yahoo.es
authors.forename: M J
authors.initials: MJ
authors.lastname: Gutiérrez
authors.forename: M
authors.initials: M
authors.lastname: Acebedo-Ribó
authors.forename: J A
authors.initials: JA
authors.lastname: García-Donaire
authors.forename: M J
authors.initials: MJ
authors.lastname: Manzanera
authors.forename: A
authors.initials: A
authors.lastname: Molina
authors.forename: E
authors.initials: E
authors.lastname: González
authors.forename: N
authors.initials: N
authors.lastname: Nungaray
authors.forename: A
authors.initials: A
authors.lastname: Andrés
authors.forename: J M
authors.initials: JM
authors.lastname: Morales
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D007165:Immunosuppression Therapy / Q000379:methods; D016030:Kidney Transplantation / Q000502:physiology*; D011247:Pregnancy; D011256:Pregnancy Outcome; D012189:Retrospective Studies