title: Ultra-high-risk pregnancies in women after renal transplantation.
abstract: OBJECTIVE
  This study evaluates pregnancy outcomes in renal transplant recipients who have additional obstetrical, surgical, or urological risk factors.
  
  
  METHODS
  Data from our transplantation and obstetrical databases were retrospectively analyzed to identify all women of reproductive age who had undergone renal transplantation between 1999 and 2013 at our tertiary referral center and had subsequently become pregnant. Characteristics of pregnancy and perinatal outcome parameters; obstetrical, urological, and surgical risk factors; and graft function were assessed. Descriptive data analysis, Fisher's exact test, unpaired Student's t-test and one-way analysis of the variance were performed.
  
  
  RESULTS
  The overall pregnancy rate after renal transplantation was 5% (n=13). 77% of the patients (n=10) had ultra-high-risk pregnancies due to additional risk factors. These included twin pregnancy, placenta previa/percreta, hypertension; previous heart transplantation, previous myocardial infarction; postoperative lymphocele, urinary leakage, hydronephrosis, or vesico-ureteral reflux. Two patients had two consecutive pregnancies. A total of 12 deliveries with 13 newborns were achieved. Cesarean section and preterm delivery rates were 67% and 50%, respectively. Mean gestational week at delivery was 36 ± 3. Mean creatinine levels were higher in women with preterm deliveries and in those of advanced age. Mean time between transplantation and delivery was 79 ± 36 months. All patients had adequate graft function after a mean follow-up of 128 ± 50 months after renal transplantation.
  
  
  CONCLUSIONS
  Pregnant women after renal transplantation commonly present with additional risk factors. In these ultra-high-risk pregnancies successful outcomes can be achieved in a multidisciplinary setting. Adequate graft function and urinary tract evaluation is necessary.
authors.affiliation: Department of Obstetrics and Gynecology, Division of Obstetrics and Fetomaternal Medicine, Medical University Vienna, Austria.
authors.forename: Alex
authors.initials: A
authors.lastname: Farr
authors.affiliation: Department of Obstetrics and Gynecology, Division of Obstetrics and Fetomaternal Medicine, Medical University Vienna, Austria.
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Bader
authors.affiliation: Department of Obstetrics and Gynecology, Division of Obstetrics and Fetomaternal Medicine, Medical University Vienna, Austria.
authors.forename: Peter W
authors.initials: PW
authors.lastname: Husslein
authors.affiliation: Department of Surgery, Division of Transplantation, Medical University Vienna, Austria.
authors.forename: Georg
authors.initials: G
authors.lastname: Györi
authors.affiliation: Department of Surgery, Division of Transplantation, Medical University Vienna, Austria.
authors.forename: Ferdinand
authors.initials: F
authors.lastname: Mühlbacher
authors.affiliation: Department of Urology, Medical University Vienna, Austria. Electronic address: markus.margreiter@meduniwien.ac.at.
authors.forename: Markus
authors.initials: M
authors.lastname: Margreiter
mesh_terms: D000328:Adult; D002585:Cesarean Section / Q000706:statistics & numerical data*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D006973:Hypertension / Q000453:epidemiology*; D007231:Infant, Newborn; D016030:Kidney Transplantation; D010923:Placenta Previa / Q000453:epidemiology*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology; D011249:Pregnancy Complications, Cardiovascular / Q000453:epidemiology*; D011256:Pregnancy Outcome; D018566:Pregnancy, High-Risk; D059285:Pregnancy, Twin / Q000706:statistics & numerical data*; D047928:Premature Birth / Q000453:epidemiology*; D012189:Retrospective Studies; D013997:Time Factors; D055815:Young Adult
keywords: High-risk pregnancy, Pregnancy outcome, Renal transplantation, Transplant outcome