Background: Fertility in women is recovered few months after kidney transplantation. However, pregnancy viability and maternal complications remain uncertain. Methods: We studied data of patients from a kidney transplant center in Brazil from 2004 to 2014. In this retrospective analysis, we identified 36 pregnant kidney transplant recipients and collected their clinical and laboratory data before pregnancy, every trimester and 12 months after delivery. Each pregnancy was considered a single event. Results: We included 53 pregnancies. The average age was 23 (12-33) years. Pregnancy occurred 4 (1-12) years after transplantation. Maintenance immunosuppression at conception was prednisone, tacrolimus and azathioprine in 73,5% of cases. The frequency of chronic hypertension was 38%, 15% had preexisting proteinuria greater than 0,3g/L, and baseline creatinine was greater than 1,5mg/dL in 19% pregnancies. 12 (22,6%) miscarriages were observed, 8 in the first trimester and 4 in the second trimester. Delivery was induced by medical conditions in 41% of cases. Cesarean delivery was performed in 49% of cases. 9 (21,9%) premature births and 7 (17,7%) very premature births were observed. Two (4,8%) stillbirths and two (4,8%) neonatal deaths occurred. Maternal complications were new onset proteinuria (45%), urinary tract infection (23%), preeclampsia (11%) and gestational hypertension (16%). During the follow-up period, two (6%) acute rejection and one (2%) graft loss occurred. Renal dysfunction was observed in 27% of pregnancies. Average baseline creatinine was compared with third trimester and 12 months follow-up creatinine and significant increase (1,18 vs. 1,47 vs. 1,58mg/dL, p<0,001) was found. Mean serum creatinine also increased in the subgroup with baseline creatinine < 1,5 mg/dL (1,17 vs. 1,24 vs. 1,58mg/dL, p<0,001). Conclusions: Although the sample is limited, high rates of miscarriage (41%), prematurity (39%) and maternal complications were found. High frequency of pre-existing hypertension (38%) and proteinuria (15%) was also observed. Pregnancy was associated with sustained increase in creatinine, even in the subgroup with lower baseline creatinine. Further research regarding the issue of pregnancy and kidney transplantation is required, in order to improve maternal safety and preserve graft function.

CITATION INFORMATION: Lima A, Cristelli M, Teixeira C, Pietrobom I, Basso G, Viana L, de Paula M, C[acirc]ndido C, Tedesco-Silva H, Pestana J. Pregnancy in the Renal Transplant Recipient: Pregnancy Viability and Effects on Graft Function. Am J Transplant. 2016;16 (suppl 3).

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