title: Pregnancy after renal transplantation--a five-yr single-center experience.
abstract: BACKGROUND
  There has been an increase in the number of pregnancies in renal transplant recipients. Our aim was to report our experience with a significant casuistic.
  
  
  METHODS
  Fifty-two pregnancies in 52 patients (January 2001 to December 2005), with two patients having a multiple pregnancy, were evaluated and patients were characterized and evaluated as clinical and obstetrical and perinatal outcomes.
  
  
  RESULTS
  Mean patient age was 26.5 yr (range 17-38) with live donors in 34 (65.4%) and cadaver donors in 18 (34.6%). The mean transplantation-pregnancy interval was 3.1 yr. Calcineurin inhibitors (cyclosporine or tacrolimus) comprised the immunosuppressive therapy in 49 pregnancies (94.2%). Pregnancy complications were chronic hypertension in 33 patients (63.5%), anemia in 31 (59.6%), urinary tract infection in 22 (42.3%) and diabetes in four (7.7%). Nine patients (17.3%) received blood transfusion. Preeclampsia was diagnosed in 16 cases (30.7%) and renal dysfunction in 23 (44.2%) with preeclampsia assumed to be the main cause. One patient (1.9%) had graft loss, as a result of hemorrhagic shock after preterm delivery at home. Premature rupture of membranes occurred in four cases (7.7%), and preterm delivery in 20 (38.4%). Sixteen (29.6%) newborn were small for gestational age. One case of neonatal death was registered as a result of excessive prematurity. Cesarean section was performed in 32 patients (61.5%), the main indications being related to hypertension syndromes and fetal distress.
  
  
  CONCLUSIONS
  This group of patients is characterized by a wide range of antenatal and perinatal problems and must be managed in specialized tertiary units to achieve the very best results.
authors.affiliation: Obstetrics Department, Federal University of Sao Paulo, Sao Paulo, Brazil. leminas@ig.com.br
authors.forename: Leandro G
authors.initials: LG
authors.lastname: Oliveira
authors.forename: Nelson
authors.initials: N
authors.lastname: Sass
authors.forename: Jussara L
authors.initials: JL
authors.lastname: Sato
authors.forename: Kikumi S
authors.initials: KS
authors.lastname: Ozaki
authors.forename: Jose O
authors.initials: JO
authors.lastname: Medina Pestana
mesh_terms: D000293:Adolescent; D000328:Adult; D002585:Cesarean Section / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016030:Kidney Transplantation; D011184:Postoperative Period; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology; D011256:Pregnancy Outcome; D018566:Pregnancy, High-Risk
chemical_list: D007166:Immunosuppressive Agents