Introduction

Pregnancies in kidney-transplanted women are at high-risk compared to the general population. The aim of this study was to assess the obstetric complications, delivery outcomes, and impact of pregnancy on kidney allograft function.

Methods

This is a retrospective study on kidney transplant recipients followed for pregnancy at the Cliniques Universitaires Saint- Luc between 1994 and 2010.

Results

Thirty-two women with a kidney transplant underwent a total of 57 pregnancies. Two were twin pregnancies. Median age at first transplantation was 24 (7-35) years. Induction therapy was given to 69% of patients, and maintenance immunosuppression consisted of triple therapy including calcineurin inhibitors (cyclosporine (78%)), azathioprine (81%) and corticosteroids (100%). Age at first pregnancy was 32 (22-39) years. At the time of contraception withdrawal, all patients were shifted from mycophenolate mofetil to azathioprine. Fourteen pregnancies (24 %) did not survive caused by miscarriages (n=9), stillborn (n=1), ectopic pregnancies (n=2), and therapeutic abortion (n=2). Live birth occurred in 76% of pregnancies. Delivery was by cesarean in 66%. The mean gestational age was 30.45 ± 11.3 weeks and 65% of newborn were premature. A low birth weight < 2500g was noted in 46%. Obstetric complications were: de novo hypertension in 4%, pre-eclampsia in 10% and gestational diabetes in 2%. Within 10 days of delivery, one woman suffered from acute rejection treated by corticosteroids. The median follow-up after delivery was 14 (4-21) years. Creatinine remained stable 5 years after delivery.

Conclusion

Pregnancies in kidney transplant recipients are successful in 2/3 of cases but are at increased risk of prematurity, delivery by cesarean and low birth weight. Kidney function is not altered. Care in specialized centers with close collaboration between obstetricians and the transplant team is advisable.

CITATION INFORMATION: Devresse A, Jassogne C, Hubinont C, de Meyer M, Mourad M, Goffin E, Kanaan N. Maternal Risks and Pregnancy Outcomes After Kidney Transplantation: A Single Center Experience. Am J Transplant. 2017;17 (suppl 3).

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