Pregnancy after kidney transplantation: two transplantation centers--Vicenza-Udine experience.
BACKGROUND
Pregnancy after kidney transplant has become possible thanks to the recent surgical and pharmacological breakthrough.


METHODS
We performed a retrospective study including all childbearing women transplanted in our centers after 1997. The following variables were analyzed: type of nephropathy, patient age when dialysis started, age at transplantation, time between dialysis and transplantation and between transplantation and baby birth. We also considered immunosuppressive therapy, type of delivery, baby weight, Apgar score, and mother and baby follow-up.


RESULTS
We followed up 13 pregnancies in 12 patients who were diagnosed with chronic pyelonephritis (n = 4), postpartum cortical necrosis (n = 1), immunoglobulin A GN (n = 4), diabetic nephropathy (n = 1), unknown nephropathy (n = 2). All patients received a cadaveric donor kidney. They were treated with calcium antagonists and alfamethyldopa for their high blood pressure. We observed 9 mother complications: nonnephrotic proteinuria (n = 1), urinary tract Infection (n = 1), pre-eclampsia (n = 4), internal placenta detachment (n = 1) and spontaneous abortions (n = 2); 4 fetal complications: IUGR (n = 2), acute distress respiratory syndrome (n = 1), Klinefelter syndrome (n = 1) and preterm births (n = 4). In 2 cases the child weight was lower when compared to the gestational age, and 5 babies were admitted to the neonatal intensive care unit. The mother's follow-up showed no acute rejection episodes. Breastfeeding was discouraged due to the transmission of immunosuppressive medications into breast milk. We did not observe significant disease upon child follow-up.


CONCLUSIONS
Our data were in agreement with the literature confirming that pregnancy after kidney transplant though possible carries elevated risks. Patients therefore are referred to highly specialized centers where obstetricians, nephrologists, intensivists, and neonatologists provide surveillance and treatment.
Di Loreto
P
P
Nephrology Dialysis Transplantation San Bortolo Hospital, Vicenza, Italy.
Martino
F
F
Chiaramonte
S
S
Dissegna
D
D
Ronco
C
C
Marchesoni
D
D
Catapano
P
P
Romano
G
G
Montanaro
D
D
D001034:Apgar Score; D001942:Breast Feeding / Q000009:adverse effects; D002585:Cesarean Section; D005260:Female; D005315:Fetal Diseases / Q000453:epidemiology; D005317:Fetal Growth Retardation; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use; D007231:Infant, Newborn; D016030:Kidney Transplantation / Q000276:immunology / Q000473:pathology / Q000502:physiology*; D011225:Pre-Eclampsia / Q000453:epidemiology; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology; D011256:Pregnancy Outcome / Q000453:epidemiology; D011644:Puerperal Disorders / Q000453:epidemiology; D012128:Respiratory Distress Syndrome; D012189:Retrospective Studies; D017211:Treatment Failure; D016896:Treatment Outcome
D007166:Immunosuppressive Agents