Pregnancy outcomes after renal transplantation. Two-year follow-up
Johanna Caldano2, Henry Darquea3, Juan P Ponti1, Maria Giordani3, Silvina Aleman2, Rosana Groppa3, Nora Imperiali3, Jihan Sleiman1, Gervasio Soler Pujol1, Carlos H Diaz1.
1Nefrologia, Centro de Educacion Medica e Investigaciones Clinicas "Norberto Quirno", Caba, Argentina; 2Nefrologia, Centro Regional de Ablacion e Implante Norte, Caba, Argentina; 3Nefrologia, Hospital Italiano de Buenos Aires, Caba, Argentina
Introduction: Kidney transplant (KT) is the most effective therapeutic for women with CKD desiring pregnancy, since it allows the recovery of renal function (RF), as well as the reestablishment of the hypothalamus-pituitary-gonadal axis, ovulation and the possibility of conception. The ideal condition to get pregnant for a woman with a KT is to have stable RF, without proteinuria and controlled blood pressure. Pregnancy after KT is possible, but it is associated with a high rate of complications which are related with decreased RF, proteinuria and hypertension during and/ or after pregnancy and moreover it should be taken into account the effect of immunosuppressive drugs in pregnancy.
Objective: To describe the graft and pregnancy outcomes among KT and kidney/pancreas transplant recipients.
Material and methods: We reviewed medical records from all pregnancies that occurred in kidney and kidney/pancreas transplant women between 1990 and 2020 in 3 transplant centers in Argentina.
Results: Twenty-five pregnancies in 22 KT recipients were identified. Median age at pregnancy was 32 years and median transplant–pregnancy interval was 5 years (range,1.5-12.7 years). Forty-eight percent of the patients had hypertension, 23% had proteinuria and 8% had creatinine > 1.5 mg/dl pre-pregnancy. The most common maintenance immunosuppression was tacrolimus or cyclosporine + azathioprine + steroids (80%). Median gestational age at delivery was 37 weeks (range, 23-39 weeks). Live birth occurred in 95% of cases. There were 2 abortions. Preterm delivery rate was 40%. Forty-seven percent of newborns had low birth weight. 36% of the women had preeclampsia, 17% cholestasis and only 1 patient had gestational diabetes. At week 20 of gestation, 36% had proteinuria and 3 months postpartum the rate increased to 80%. Thirteen percent had postpartum rejection. There was a significant increase in creatinine at baseline, at week 20 and postpartum (1.12 vs. 1.15 vs. 2.18, p<0.001). Fourteen (14%) percent had lost graft function (LGF) at 2 years postpartum.
Conclusions: In this small sample, the rate of complications was high, with only 14% of LGF. We recommend the development of a nationwide registry in order to provide the true risk of maternal and fetal complications in KT in our country.
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