PREGNANCY AND RENAL TRANSPLANT

Abstract

A126 Fertility is one of the impaired function in end stage renal disease that improves with kidney transplant, which makes pregnancy possible, although a high risk one. With the current survival rate of renal transplant pregnancy has become frequent. Aim: To describe the pregnancy evolution of renal transplant patients in our hospital Methods: From October 1987 to March 2004 we performed 499 kidney transplants of which 215 (43%) were women. Retrospectively 15 renal transplant patients with 17 pregnancies were evaluated. Results: Mean age at the pregnancy diagnosis was 30.8 years (19-39) and the mean transplant time was 3 years (10 m-8 y). The etiologies of end stage renal disease were: Unknown 9 (60%); Glomerulopathies 3 (20%); Nephronophthisis 1 (6.6%); Chronic Pyelonephritis 1 (6.6%) y Polycystic kidney disease 1 (6.6%). Immunosuppression was: Cyclosporine-Prednisone: 6P (40%); Cyclosporine-Azathioprine-Prednisone: 8P (53%); Tacrolimus-Prednisone: 1P (6.6%). Eleven patients had controlled hypertension previously (73%). Results: There were 18 newborn of 17 pregnancies (2 twins), 14 were born alive (77.7%) and of these 10 were preterm (3 intrauterine growth retardation) and 4 (28.5%) at term. There were 2 spontaneous abortions (11.1%); 1 intrauterine death (5.5%); and 1 stillborn (5.5%). There were eleven urinary tract infections (64.7%) and there was no graft loss. There were 3 acute rejection episodes (17.6%). Thirteen patients (76.4%) showed a plasmatic creatinine increase, of which 5 (29.4%) had renal function impairment before conception. Elevated creatinine levels persisted in 11 patients (64.7%) at immediate postpartum, proteinuria was increased in 8 patients (47%) and persisted in 5 patients (29.4%) with high values at immediate postpartum. Seven patients developed preeclampsia (41%). Six (46%) partum were vaginal and 7 (57.8%) were cesarean for obstetrics reasons. Conclusions: There was a high urinary tract infection incidence, with recurrence in three patients. Acute rejection was more frequent in patients with previous episodes with increase renal function impairment and with previous urinary tract infection which might have triggered it. There was an elevated preterm incidence which might result from different factors: elevated creatinine, hypertension worsening and proteinuria which caused the pregnancy interruption.