Pregnancy after kidney transplantation: a single-center experience and review of the literature.
After kidney transplantation (KT), pregnancy is possible, although the risk of maternal and fetal complications is much higher than in the general population. Outcome of 22 pregnancies in 17 patients transplanted in the Gdańsk center in the period 1980-2012 was studied. Mean maternal age at pregnancy was 30 ± 5 (range, 23-39) years, interval between transplantation and conception 3.4 ± 2.5 (range, 0.6-11) years. Mean creatinine concentration before conception was 1.29 ± 0.36 (range, 0.8-2.45) mg/dL and was stable during 1 year preceding pregnancy (mean increase, 0.01 mg/dL). Nine of the 17 patients received 1 and 4 received ≥2 antihypertensive drugs, and 1 had proteinuria. Twelve of the 17 patients were primagravidas, 1 was pregnant 3 times, and 14 times. At the time of conception, 20 patients received CNI (14 cyclosporine, 6 tacrolimus), 15 antimetabolites (3 mycophenolate mofetil [MMF], 12 azathioprine), 1 mammalian target of rapamycin inhibitor (mTORi; sirolimus), and all prednisone. MMF and mTORi were discontinued before or during the 1st weeks of pregnancy. Maternal outcome: all survived the pregnancy. None experienced rejection or graft loss as a direct result of pregnancy. Maternal complications included edema (5/17), worsening of blood pressure control (5/17), and worsening (1/17) or new onset of proteinuria (2/17). Mean creatinine decrease during pregnancy was 0.06 mg/dL. Mean creatinine 1 year after pregnancy was 1.49 ± 0.53 mg/dL. There were 12 cesarean sections. Fetal outcomes: 17 live births (2 with serious congenital defects), 2 spontaneous and 1 induced abortion, 2 stillbirths. Mean pregnancy age and neonate birth weights were 35 ± 4 (range, 23-39) weeks and 2,552 ± 629 (range, 1,480-3,420) g, respectively. During mean 8.5 (range, 1-25) years of follow-up after pregnancy, 4/17 patients lost grafts. Grafts were lost in the 3rd to 7th years after pregnancy. We conclude that pregnancy does not exert a direct negative influence on patient and graft survivals; 68% of all pregnancies resulted in delivering healthy neonates.
Department of Nephrology, Transplantology, and Internal Medicine, Medical University of Gdańsk, Poland.
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Dębska-Ślizień
Department of Nephrology, Transplantology, and Internal Medicine, Medical University of Gdańsk, Poland.
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Gałgowska
Department of Nephrology, Transplantology, and Internal Medicine, Medical University of Gdańsk, Poland; Department of General Nursing, Medical University of Gdańsk, Poland.
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Chamienia
Department of Nephrology, Transplantology, and Internal Medicine, Medical University of Gdańsk, Poland.
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Bułło-Piontecka
Department of Nephrology, Transplantology, and Internal Medicine, Medical University of Gdańsk, Poland.
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Król
Department of Nephrology, Transplantology, and Internal Medicine, Medical University of Gdańsk, Poland.
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Lichodziejewska-Niemierko
Department of Nephrology, Transplantology, and Internal Medicine, Medical University of Gdańsk, Poland.
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Lizakowski
Department of Occupational and Internal Medicine, Medical University of Gdańsk, Poland.
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Renke
Department of Nephrology, Transplantology, and Internal Medicine, Medical University of Gdańsk, Poland.
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Rutkowski
Department of Internal Medicine, Connective Tissue Diseases, and Geriatrics, Medical University of Gdańsk, Poland.
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Zdrojewski
Department of Obstetrics, Medical University of Gdańsk, Poland.
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Preis
Department of General, Endocrine, and Transplant Surgery, Medical University of Gdańsk, Poland.
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Sledziński
Department of Nephrology, Transplantology, and Internal Medicine, Medical University of Gdańsk, Poland.
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Rutkowski
D000328:Adult; D001724:Birth Weight; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006801:Humans; D007231:Infant, Newborn; D007676:Kidney Failure, Chronic / Q000150:complications / Q000601:surgery*; D016030:Kidney Transplantation; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000209:etiology*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000209:etiology*; D012189:Retrospective Studies; D055815:Young Adult