Pregnancy After Renal Transplantation: Ten-Year Single-Center Experience

There has been an increase in the number of pregnancies among renal transplant
recipients. Our experience included 61 pregnancies in 53 patients from January 1997 to
April 2007, with 6 patients having multiple pregnancies. Patients were studied for clinical,
obstetrical, and perinatal outcomes. The mean patient age was 24.5 years (range, 19–38).
They all received living donor kidneys. The mean transplantation–pregnancy interval was
2.7 years (range, 1.7–5.3 years). Immunosuppressive drugs consisted of cyclosporine
(CsA), mycophenolate mofetil (MMF), and prednisolone (pred) in 38 patients (72%); CsA,
azathioprine (AZA), plus pred were used in 15 patients (28%). Pregnancy complications were
chronic hypertension in 21 patients (40%), anemia in 28 (52.6%), and urinary tract infection
in 18 (34%). Twelve patients (22.6%) received blood transfusions. Pre-eclampsia was
diagnosed in 14 cases (26.4%) and renal dysfunction in 11 (20.7%) with pre-eclampsia assumed
to be the main cause. Three patients (5.6%) had graft losses as a result of hemorrhagic shock,
sepsis, and eclampsia. Premature rupture of membranes occurred in 6 cases (11.3%), and
preterm delivery occurred in 14 cases (26.4%). Eleven (20.7%) newborns were small for
gestational age. One club foot and one large facial hemangioma occurred in 2 infants,
respectively. One case of neonatal death was registered as a result of excessive prematurity.
One mother died due to sepsis. Cesarean section was performed in 24 patients (45.2%), the
main indications being related to hypertension and fetal distress. There were no significant
differences between MMF-treated and AZA-treated patients with respect to clinical, obstetrical,
and perinatal outcomes. This group of patients was characterized by a wide range of
antenatal and perinatal problems that must be managed in specialized tertiary units to achieve
the best results. MMF may be as safe as AZA in pregnancy