PREGNANCY IN KIDNEY TRANSPLANTATION; SAFETY TO MOTHER, NEONATE AND ALLOGRAFT

Abstract

327 BACKGROUND: Conception in transplant woman has been considered as a morbid factor for patient, neonate and graft survival. METHOD: We retrospectively reviewed 48 pregnancies in 36 female kidney recipients until February, 1998 at our institution. Al patients were maintained on cyclosporine-based immunosuppressive regimen before, during and after pregnancy. Patients were divided into two groups; group 1 (delivery group) of 25 women with 26 pregnancies and group 2 (abortion group) of 19 women with 22 pregnancies. RESULTS: Mean interval between renal transplantation and conception is 31.8±22.9 months. Serum creatinine was reported before, during and after pregnancy for the evaluation of graft function and there was no significant changes of graft function in both groups. Mean daily dosage of cyclosporine had been stable in all patients during the study period. Average gestational age was 37.0±2.0 weeks. The incidence of very low birth weight (VLBL), low birth weight (LBL) and small for gestational age (SGA) were 7.7%, 63.5% and 84.6%, respectively. The most common pregnancy-related complication was urinary tract infection of 11 cases followed by preeclampsia of 7 cases, hypertension of 4 cases and proteinuria of 3 cases in group 1. There was no episode of acute rejection or graft loss during pregnancy. Premature deliveries within 37 weeks of conception were 12 cases (46.2%). LBL of neonate was significantly related with maternal pre-pregnant hypertension (1793.3±393.0 gm in patients with hypertension vs. 2471.2±468.1 gm in patients without hypertension, p=0.001). CONCLUSION: Pregnancy in female renal allograft recipient is relatively safe to mother, neonate and graft while they are treated with adequate dosage of cyclosporine and monitoring of graft function by continuous serum creatinine levels.