Pregnancy And Delivery After Renal Transplantation: Report Of 4 Cases And Review Of The Literature

OBJETIVENeither pregnancy nor delivery is easy in female patients with chronic renal failure. Kidney transplantation(KT) is the best treatment to patients with end stage renal failure (ESRF). After KT, childbirth is possible when the graft function is good. However, there are few guidelines for pregnancy permission. Due to the low incidence in China, most studies are case reports, which leads to the lacking of systematic understanding of pregnancy and delivery after KT. It’s a cross discipline involving obstetrics & gynecology (OBGY), midwives and renal department. The aim of the present paper is to report and summarize the clinical features the four cases in our hospital, and to improve the basis upon which advice on pregnancy is given to renal transplant recipients in the reproductive-age group.METHODSWe analyzed retrospectively the clinical data of 4 cases treated in our hospital since records in Lianzhong system. With review of the literature, we have a summary of the features of transplantation-pregnancy internal (TPI), obstetric complications, cesarean section (CS) or vaginal delivery (VD), pregnancy induced hypertention (PIH), renal failure(RF), immunosuppressant, preterm birth and breastfeeding.RESULTAll of the cases we report are of reproductive age, one of them have a previous pregnancy which ends with induced abortion after RT. TPI ranges from more than 2 years to 10 years.3 of the 4 cases have PIH, with 1 of which have preeclampsia.3 of them have abnormal graft function, their highest serum creatinine (SCr) in perinatal period are 143umol/L,160.9umol/L and 188.2umol/L.2 of them have been examined by B-ultrasound scan(BUS),1 of which showed no abnormality, while the other showed hydronephrosis and collecting system separation of the transplanted kidney.2 of them are admitted twice with the first admission to avoid abortion. Pregnancy complications included PIH, premature labor and increased proportion of CS, and all of the 4 cases,3 of whom are preterm labor, end up with CS rather than VD. The immunosuppressant includes tacrolimus (FK506),azathioprine (AZA) and prednisone with different doses. The newboms all have a good state of health with Apgar score 10/10 in l/5min. All of them accept artificial rather than breast feeding for the worry of immunosuppression.2 of them are admitted to neonatal department with feeding or breathing problem. They are discharged within 4 to 12 days with a good prognosis.CONCLUSIONCounseling regarding pregnancy should be an integral part of caring for the kidney transplant patients in the reproductive-age women. Pregnancy following KT may be associated with serious maternal and fetal complications, however, with the help of good surveillance and treatment, it’s a promising result. Due to the low incidence of pregnancy and delivery after kidney transplantation in China, we don’t have much up-to-date systematic evidence-based informations on the predictable outcome and the risk of pregnancy after kidney transplantation. The need for further and multicenter observational studies cannot be over emphasized to help answer our considerable gaps in this area.