Pregnancy in renal transplant recipients: the Royal Free Hospital experience

• Published in: QJM : An International Journal of Medicine Vol. 96; no. 11; pp. 837 - 844
• Main Authors: Thompson, B.C., Kingdon, E.J., Tuck, S.M., Fernando, O.N., Sweny, P.
• Format: Journal Article
• Language: English
• Published: Oxford Oxford University Press 01.11.2003; Oxford Publishing Limited (England)
• Subjects: Adult; Antihypertensive Agents - therapeutic use; Biological and medical sciences; Birth Weight - physiology; Creatinine - blood; Diseases of mother, fetus and pregnancy; Female; Fetal Growth Retardation - etiology; Gestational Age; Gynecology. Andrology. Obstetrics; Humans; Immunosuppressive Agents - therapeutic use; Infant, Newborn; Infant, Small for Gestational Age; Kidney - physiopathology; Kidney Failure, Chronic - physiopathology; Kidney Failure, Chronic - surgery; Kidney Transplantation; Medical sciences; Pre-Eclampsia - etiology; Pregnancy; Pregnancy Outcome; Pregnancy. Fetus. Placenta; Retrospective Studies; Time Factors; Treatment Failure; United Kingdom; Europe; Kidney disease; Human; Urinary system disease; Prevalence; Terminal stage; Recipient; Transplantation; Review; Pregnancy; Female genital system; Risk factor; Renal failure; Female
• ISSN: 1460-2725; 1460-2393
• DOI: 10.1093/qjmed/hcg142

Background: For women with end-stage renal failure of child-bearing age, renal transplantation offers a chance to start a family. Pregnancies in renal transplant recipients involve risks for graft and fetus, and need to be carefully managed. Aim: To identify graft, fetal and maternal outcomes in our patients, and compare our results with those of the large national transplant registries. Design: Retrospective case-note review. Methods: We assessed the outcomes of 48 pregnancies in 24 renal transplant recipients. Obstetric data and renal parameters were examined in 27–30 pregnancies that progressed to delivery. Results: Mean time from transplantation to pregnancy was 6.5 years, with an unfavourable outcome in patients who conceived within 1 year. There was a 41% incidence of fetal growth restriction (FGR), and 33% of infants were small for gestational age. FGR was associated with maternal hypertension, a pre-pregnancy serum creatinine (SCr) ≥ 133 μmol/l (1.5 mg/dl), calcineurin inhibitors and the use of cardioselective β blockers. Two patients with pre-pregnancy SCr > 200 μmol/l lost their grafts within 3 years of delivery. A permanent significant decline in graft function occurred in 20%, by 6 months post delivery. Discussion: FGR with SGA infants occurs frequently. Atenolol should be avoided in pregnancy and Metoprolol should not be combined with calcineurin inhibitors. Pregnancy appeared to have a deleterious effect on graft function in patients with SCr > 155 μmol (1.75 mg/dl). Patients with pre-pregnancy SCr  200 μmol/l are at greatest risk.