Nephrology Xagena

Pregnancy after kidney transplant associated with high risks

Pregnancy after kidney transplant has become possible thanks to the recent surgical and pharmacological breakthrough.

Researchers have performed a retrospective study including all childbearing women transplanted in their centers ( Vicenza and Udine ) after 1997.
The following variables were analyzed: type of nephropathy, patient age when dialysis started, age at transplantation, time between dialysis and transplantation and between transplantation and baby birth.
It has also been considered immunosuppressive therapy, type of delivery, baby weight, Apgar score, and mother and baby follow-up.

Investigators have followed up 13 pregnancies in 12 patients who were diagnosed with chronic pyelonephritis ( n=4 ), postpartum cortical necrosis ( n=1 ), immunoglobulin A GN ( n = 4 ), diabetic nephropathy ( n=1), unknown nephropathy ( n=2 ).

All patients have received a cadaveric donor kidney.

They were treated with calcium antagonists and alfa-Methyldopa for their high blood pressure.

Researchers have observed 9 mother complications: nonnephrotic proteinuria ( n=1), urinary tract infection ( n=1 ), pre-eclampsia ( n=4 ), internal placenta detachment ( n=1 ) and spontaneous abortions ( n=2 ); 4 fetal complications: IUGR [ intrauterine growth restriction ] ( n=2 ), acute distress respiratory syndrome ( n=1 ), Klinefelter syndrome ( n=1 ) and preterm births ( n=4 ).

In 2 cases the child weight was lower when compared to the gestational age, and 5 babies were admitted to the neonatal intensive care unit.

The mother's follow-up showed no acute rejection episodes. Breastfeeding was discouraged due to the transmission of immunosuppressive medications into breast milk.

Researchers did not observe significant disease upon child follow-up.

The data were in agreement with the literature confirming that pregnancy after kidney transplant though possible carries elevated risks.
Patients therefore are referred to highly specialized centers where obstetricians, nephrologists, intensivists, and neonatologists provide surveillance and treatment. ( Xagena )

Di Loreto P et al, Transplant Proc 2010; 42: 1158-1161