Successful Pregnancies in Kidney Transplant Recipients: Experience of the National Kidney Transplant Program From Uruguay.
BACKGROUND
Renal transplantation increases the possibilities of pregnancy in women of reproductive age. The course of pregnancy was analyzed retrospectively in patients with kidney or kidney-pancreas transplant, surveying maternal-fetal or renal graft complications and the relation with pre-pregnancy renal function.


METHODS
A cohort that includes all the kidney transplant recipients who went through pregnancy in Uruguay in a period of 28 years is described. Forty pregnancies in 32 patients were registered; the average time between the kidney transplant and the beginning of the gestation period was 47 months. From the total gestations, 10 abortions, 1 neonatal death, and 1 fetal demise were registered. From the remaining pregnancies, we highlight prematurity (18/29) and low birth weight (14/21). Twenty-nine in 30 pregnancies ended in cesarean section; in 8 of 30, pre-eclampsia diagnosis was performed. Acute rejection was diagnosed in 2 of 30 pregnancies, both undergoing their first post-transplant year.


RESULTS
Two patients required dialysis throughout the pregnancy because of progress into severe renal insufficiency. Higher obstetric perinatal morbidity and renal function deterioration was related to lower pre-pregnancy glomerular filtration rate (GFR).


CONCLUSIONS
A successful pregnancy is possible in transplant recipients, yet there are risks of prematurity, low birth weight, and abortion. A lower GFR before pregnancy was associated with poorer maternal and perinatal results as shown in the different series.
Nephrology and Urology Institute, Montevideo, Uruguay.
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Orihuela
Nephrology and Urology Institute, Montevideo, Uruguay; Department of Nephrology, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay. Electronic address: mninvaez@gmail.com.
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M
Nin
Department of Nephrology, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay.
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San Román
Department of Nephrology, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay.
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Noboa
Nephrology and Urology Institute, Montevideo, Uruguay.
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Curi
Department of Nephrology, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay.
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R
Silvariño
Nephrology and Urology Institute, Montevideo, Uruguay; Department of Nephrology, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay.
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F
González-Martínez
D000022:Abortion, Spontaneous / Q000453:epidemiology; D000328:Adult; D002585:Cesarean Section / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007676:Kidney Failure, Chronic / Q000503:physiopathology / Q000601:surgery; D016030:Kidney Transplantation / Q000706:statistics & numerical data*; D016035:Pancreas Transplantation / Q000706:statistics & numerical data; D011182:Postoperative Care; D016742:Preconception Care; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology*; D011256:Pregnancy Outcome / Q000453:epidemiology; D047928:Premature Birth / Q000453:epidemiology; D012189:Retrospective Studies; D066027:Transplant Recipients / Q000706:statistics & numerical data; D014583:Uruguay / Q000453:epidemiology; D055815:Young Adult