Successful pregnancy after simultaneous pancreas-kidney transplantation

Area of Science:

• Nephrology
• Endocrinology
• Transplant Surgery

Background:

• Simultaneous pancreas-kidney transplantation (SPKT) is a treatment for type 1 diabetes mellitus with end-stage renal disease.
• Pregnancy outcomes in SPKT recipients are not well-documented, necessitating case reports to expand clinical experience.

Observation:

• A 35-year-old female SPKT recipient with a history of type 1 diabetes mellitus-complicated nephropathy became pregnant.
• Pregnancy management involved a multidisciplinary team, including transplant specialists, nephrologists, endocrinologists, and obstetricians.
• Maternal glycemic control remained stable throughout pregnancy, with normal blood glucose and HbA1c levels, negating the need for insulin therapy.

Findings:

• The recipient experienced a decline in renal function, leading to an elective Cesarean section at 30 weeks gestation.
• A male infant weighing 1.18 kg, appropriate for gestational age, was delivered.
• The neonate required intensive care for hypothermia and respiratory distress, necessitating ventilation and an 11-week neonatal special care unit stay.
• At 18 months postpartum, the infant exhibited normal developmental milestones.
• Both the pancreas and kidney grafts maintained optimal function without deterioration in the mother.

Implications:

• This case demonstrates the feasibility of pregnancy in SPKT recipients with careful multidisciplinary management.
• It underscores the importance of vigilant monitoring for potential complications, such as renal function decline and neonatal respiratory issues.
• Long-term graft survival and favorable infant neurodevelopmental outcomes are achievable following SPKT in pregnancy.