Pregnancy after kidney transplantation: graft, mother, and newborn complications

An important benefit associated with kidney transplantation (KT) in women of childbearing age is increased fertility. We retrospectively evaluated the complications associated with 24 pregnancies among our KT over 28 years. In particular, we examined the evolution of serum creatinine as well as maternal and fetal complications. To assess the impact on graft survival, our control group included women without pregnancy who were matched for age at KT, year of KT, and follow-up time. Most women (79.2%) were primiparous. All were prescribed a calcineurin inhibitor, which in 75% of the cases was cyclosporine. Overall, 45.8% had prior hypertension, only one of whom remained on the previous antihypertensive regimen. The drugs most often used were nifedipine and methyldopa. The median age at time of KT was 24.16 (interquartile range [IQR] 21.33 to 29.72) years and at delivery, 28.39 (IQR 25.59 to 33.88) years. The average interval between KT and delivery was 4.5 ± 2.7 years (range, 1 to 10 years). Maternal complications were anemia (n = 16), graft pyelonephritis (n = 6), preeclampsia (n = 6), de novo proteinuria > 1 g/d (n = 3), or gestational diabetes mellitus (n = 2). There was no acute rejection episode or opportunistic infection. The fetal complications included delayed intrauterine growth (n = 8), preterm deliveries (n = 13), or congenital enzymatic deficit (n = 1). One case was a twin pregnancy. The average gestational age was 35.2 ± 3 weeks, and the mean birth weight 2318.2 ± 597.1 grams. In 16 pregnancies, deliveries were performed by caesarean section. The median serum creatinine at 1 month before conception was 1.20 (IQR 0.97 to 1.37) mg/dL and at 1 year after delivery it had tended to increase to 1 to 20 (IQR 1.03 to 1.50) mg/dL. Death-censored graft survival did not differ from the control group. In conclusion, pregnancy after KT may be associated with serious maternal and fetal complications. We did not observe an increased risk of graft loss.