Impact of pregnancy on the function of transplanted kidneys

Abstract

Introduction. This study reviewed the course of pregnancies in terms of impact on renal function and delivery-related data among women who received kidney transplants in our unit. Methods. We reviewed the medical records of women transplanted between 1982 and 2002 who became pregnant. We recorded the data of medical, obstetrical, and transplant-related complications, plasma creatinine levels, and blood pressures at baseline, delivery, and 12 months after delivery.

Results. Thirty women had 37 pregnancies. Immunosuppressive protocols included cyclosporine, ketoconazole, azathioprine, and prednisone in 22 patients or azathioprine and prednisone in 15. Renal function decreased significantly: mean creatinine levels at baseline, delivery, and after 1 year were: 1.19 ± 0.38 mg/dL; 1.44 ± 0.70 mg/dL; and 1.38 ± 0.53 mg/dL, respectively (P = .023 and P = .004 vs baseline respectively). Systolic and diastolic blood pressures at delivery were higher than at baseline (134 ± 19 and 86 ± 14 mm Hg vs 126 ± 21 and 79 ± 13 mm Hg (P = .029 and P = .053, respectively). These values normalized 1 year later (128 ± 21 and 80 ± 16). Decreased use of antihypertensive drugs were the cause of poor blood pressure control (1.8 ± 1.3 vs 0.9 ± 0.7, P < .01). Blood pressure control improved following delivery. The most frequent complications were preeclampsia (18, 9%), intrahepatic cholestasis (13.5%), and urinary tract infections (13.5%). There were five rejection episodes. Seven miscarriages took place and one mole. Eleven pregnancies were uncomplicated.

Conclusion. Renal transplantation is the best treatment for fertile women with end-stage renal disease who want to become pregnant. However, pregnancy is risky for the mother, fetus, newborn, and allograft.