Abstract
The optimal timing for pregnancy after kidney transplant remains uncertain, due to the risk of allograft failure. In the last consensus of American Transplant Society, this interval decreased from 2 years to 1 year, due to advanced maternal age with fewer childbearing years and lower risk of rejection with the more recent and potent immunosuppressive strategies. Analyze whether the interval between transplantation and pregnancy (TTPI) influences obstetric outcomes. Medical records from a retrospective cohort of pregnancies following kidney transplanted in our department, since 1989 (n = 41), were analyzed. Obstetric and neonatal outcomes were compared according to transplantation-to-pregnancy interval (TTPI). Statistical analysis was performed using SPSS® version 22.0 (p = 0,05). The study includes 41 pregnant patients after kidney transplant, 4 (10%) in the first year, 7 (17%) in second year and 30 (73%) after 24 months. Within the first year after transplantation, we observed a higher incidence of fetal growth restriction (66,7% vs 18,2%, p = 0,06), preterm labor (100% vs 54,5%, p = 0,06) and low and very low birth weight (100% vs 51,5%, p = 0,05 and 66,7% vs 6,1%, p = 0,013). Mean gestational age (32,3 ± 0,6 [32–33] vs 35,8 ± 2,5 [29–39] weeks, p = 0,04) and weight at delivery (1500 ± 282[1300–1700] vs 2523 ± 642[885–3740], p = 0,04) were significantly lower 1 year after transplant. In the second year, the incidence of gestational hypertension (57%) is similar to first year (33%), but significantly higher when compared with TTPI > 24 months (15%, p = 0,03). With a transplantation-to-pregnancy interval higher than 2 years, the incidence of urinary infections is higher (27% vs 0%, p = 0,02). Regarding the obstetric outcomes and according to our results, the ideal time for pregnancy after transplantation is between 12 and 24 months, with a lower risk of urinary infections, restriction of fetal growth, preterm birth and low birth weight.
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