J Gałgowska, A Dębska-Ślizień, W Wołyniec, A Milecka, G Moszkowska, B Rutkowski
Ann Transplant 2009; 14(1): 49-49
Background: Successful pregnancy in haemodialysed women is rare. After
kidney transplantation (KT) pregnancy is possible but the risk of maternal
and foetal complications is increased.
Material/Methods: We examined retrospectively the outcome of 15 pregnancies in 13 patients after KT in Gdańsk centre in the period 1987-2008.
Results: Mean maternal age at pregnancy was 29.7±4.2 (range 24-37) years.
Mean interval between transplantation and conception was 30.9±18.6 (range
7-62) months. Mean creatinine concentration at conception was 1.35±0.39
(range 0.9-2.45) mg/dl, hypertension was presented in 7/13 women (2 received more than 1 anti- hypertensive drug), none had urine spot proteinuria. There were 2 conceptions within the first year of transplantation, and 6 within the second year of transplantation. Out of 13 women, 8 were primagravidas. At conception, 8 women received protocol with cyclosporine (CsA/MMF/P - 4, CsA/Aza/P - 4), 3 with tacrolimus (TAC/MMF/P-2, TAC/Rapa-1), and 2 azathioprine with prednisone. Mycofenolate mofetil was discontinued before pregnancy and rapamycine during the first few weeks of pregnancy. Foetal outcomes included: 13 live births, 1 spontaneous abortion, and 1 stillbirth. Mean pregnancy age was 35.5±3.5 (range 26-39) weeks. There were 9 caesarean sections. Among the live births, there was 1 neonatal death due to multiple lethal malformations, 1 child developed a severe neurological defect. There was 1 case of imminent asphyxia. Out of 15 pregnancies, maternal complications included ankle oedema (4/13), worsening of blood pressure control (3/13), 1 imminent abortion, 1 cervical insufficiency, 1 anhydramion. One mother returned on dialysis 7 years after successful pregnancy, the remaining live with functioning grafts.
Keywords: Kidney Transplantation