Elsevier

Transplantation Proceedings

Volume 38, Issue 7, September 2006, Pages 2001-2002
Transplantation Proceedings

Renal transplantation
Outcome
Outcome of Pregnancy in Renal Allograft Recipients: SIUT Experience

https://doi.org/10.1016/j.transproceed.2006.06.020Get rights and content

Abstract

The course of pregnancy and its outcome was studied in renal allograft recipients. Between November 1985 and November 2005, a total of 1481 renal transplants were carried out at the Sindh Institute of Urology and Transplantation (SIUT); among them were 348 females, with 73 potential females for pregnancy. All patients received cyclosporine and prednisolone, with 82% also receiving azathioprine and 4 patients mycophenolate mofetil as a third immunosuppressant drug. We evaluated incidence of hypertension, diabetes, pre-eclampsia, urinary tract infection (UTI), rejection during pregnancy and during 3 months’ postdelivery as well as outcomes of pregnancy. Among 73 potential candidates, 31 had 47 pregnancies, after an average of 31 months (8–86 months). Of 31 subjects, 21 subjects were hypertensive on one or two drugs prior to conception. A rise in blood pressure during pregnancy was noticed in 7 patients. Albuminuria from trace to 3+ appeared in 13 patients and glycosuria in one other. Blood sugar levels remained within normal range in all subjects. UTIs occurred during pregnancy in 7 patients. Among 47 pregnancies, 9 had abortions (7 spontaneous, 2 therapeutic) and 6 had preterm deliveries. The others were full-term deliveries: 12 via a lower segment caesarean section and 20 were normal vaginal deliveries. Average birth weight was 4.8 lbs. At an average follow-up of 38 months the serum creatinine values ranged from 0.94 to 2.3 mg %. One patient developed acute irreversible graft dysfunction soon after delivery. Our study demonstrated that pregnancy did not reduce renal graft survival, but newborns are at greater risk of premature birth and low birth weight.

Section snippets

Patients and methods

From November 1985 to November 2005, a total of 348 female patients received renal allografts at our center. After excluding unmarried, divorced, those who had not completed 1 year posttransplant, or expired during first transplant year, and also those who had not yet delivered, there were 73 females of reproductive age. Parameters studied were immunosuppressive agents, episodes of rejection and antirejection treatment, presence of hypertension prior to pregnancy, new-onset hypertension,

Results

There were 47 pregnancies observed in 31 patients. Twenty-four patients were prescribed immunosuppression with CyA, AZA, Pred, except one on FK, MMF and Pred, and 7 were on two drugs: 5 received cyclosporine (CyA) and prednisolone (Pred) 2 azathioprine (AZA) and Pred due to CyA being discontinued at 17 and 36 months. Three patients had vascular rejections during the first posttransplant week, requiring ATG in two and OKT3 in one. None of the patients had acute rejection during pregnancy.

Median

Discussion

Many factors affect long-term graft survival, including HLA matching, renal ischemic injury, rejection episodes, hypertension, donor age and gender, as well as hyperlipidemia.6, 7 Pregnancy, as reported earlier, does not affect graft survival in the long term,2, 3, 4, 5 but the risk of graft dysfunction and poor pregnancy outcome both increase with baseline serum creatinine values at time of conception. Those women who have serum creatinine >1.75 mg/dL have reportedly shown further

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