Pregnancy after kidney transplantation: recent experience from a combined obstetric nephrology service
Background Documented pregnancy outcomes in kidney transplant recipients are critical to inform future clinical practice.
Method Retrospective notes survey of nine pregnancies between September 2007 and December 2010 in six kidney transplant recipients and two kidney-pancreas (KP) recipients.
Results Mean age was 34 years (range 28–43). Primary renal diagnoses included Type 1 diabetes, hypertension, reflux nephropathy and glomerulonephritis. One woman had posttransplant diabetes prepregnancy.
Six women had livebirths, one woman had both a spontaneous abortion and a medically advised therapeutic abortion. One KP recipient had a spontaneous abortion.
Five women with livebirths had pre-existing hypertension, three of these requiring additional antihypertensive therapy. One KP recipient required insulin treatment during pregnancy and postpartum.
Mean (range) serum creatinine at booking, 20 weeks gestation and early postpartum was 126 µmol/l (97–185), 114 µmol/l (85–205) and 129 µmol/l (101–185), respectively.
Five women had more than one urinary tract infection during pregnancy; three were treated with prophylactic cephalexin. There were no episodes of graft rejection.
Five women developed preeclampsia and in these, birthweight and gestation were 2070 g (1020–2600) and 33.6 weeks (29.7–36.0) respectively. In the absence of preeclampsia, birthweight and gestation were 3000 g (2900–3100) and 38.2 weeks (38.1–38.3) respectively. Mean gestation overall was 35.2 weeks (29.6–38.3). Five babies were delivered by caesarean section. Three babies whose mothers had preeclampsia were admitted to SCBU.
Conclusion Even with good graft function, and optimal pregnancy care pregnancy following kidney and kidney/pancreas transplantation remain at high risk of pregnancy complications.