Predictors of Pregnancy Outcome in Renal transplant Recipients

Abstract

Objective: To identify preconceptional risk predictors specific to renal transplant patients.Methods: Preconception selection criteria which influenced the perinatal outcome in 23 pregnancies in 20 renal transplant patients at British Columbia’s Women’s and Children’s Hospital in the period 1989 to 1999 were retrospectively analyzed. Successful pregnancy outcome in this series was defined as delivery after 34 weeks, birth weight appropriate for gestational age, stable renal graft function, and no evidence of rejection within at least two years after the pregnancy.Results: Seventy-five percent of patients with preconceptional serum creatinine of less than 125 µmol/L had successful pregnancy outcomes compared to 25 percent of those with serum creatinine greater than 125 µmol/L (p = 0.11). Fifteen percent of patients with pre-existing proteinuria of one to three g per day had worsening proteinuria, renal graft function, and hypertension, and subsequently had graft rejection (p = 0.0006). Seventy-two percent of patients with poorly controlled hypertension delivered prior to 34 weeks (p = 0.008). Renal graft rejection was strongly associated with prepregnancy creatinine more than 125 µmol/L (p = 0.004), preexisting proteinuria more than one g per day (p = 0.001), and poorly controlled chronic hypertension (p = 0.04). Prematurity due to obstetric intervention with worsening maternal or fetal condition (28%) was the major contributor to perinatal morbidity and mortality. Intrauterine growth restriction was observed in 23 percent of these pregnancies.Conclusion: Pregnancy does not have a detrimental effect on renal graft survival, provided that renal graft function is normal at the time of conception.