Challenges of pregnancy in pancreas-kidney transplant recipients: Experience from our center

Chronic kidney disease affects up to 6% of women of childbearing age, leading to fertility issues and low pregnancy rates. In patients with diabetes mellitus and chronic kidney disease, simultaneous pancreas-kidney transplantation restores renal function and endogenous insulin production, thereby increasing the likelihood of a successful pregnancy. However, pregnancy after transplantation remains high-risk. Several factors may influence maternal and fetal outcomes, including preconception counseling, appropriate maternal medical management, and the careful selection of immunosuppressive therapy to avoid fetal toxicity. Although obstetric, perinatal, and nephrology care have improved since the first reported pregnancy in a simultaneous pancreas-kidney transplantation recipient in 1986, further research is still needed to fully understand its impact on maternal, fetal, and graft outcomes, particularly in the context of combined organ transplantation. The objective of this study is to describe the clinical course of pregnant simultaneous pancreas-kidney transplantation recipients and to evaluate both the impact of transplantation on pregnancy and the prognostic factors that may influence outcomes.

We conducted a descriptive analysis of a case series involving six pregnancies in simultaneous pancreas-kidney transplantation recipients managed at our center. Renal and pancreatic graft function, as well as maternal and fetal outcomes during gestation, were summarized quantitatively and graphically. Detailed, anonymized clinical data were collected for each patient throughout the follow-up period.

All pregnancies occurred more than one year after transplantation, allowing for adjustment of immunosuppressive regimens to minimize teratogenic risk. Renal and pancreatic graft function remained stable throughout the follow-up. Three patients experienced uncomplicated pregnancies. The remaining three required hospitalization due to complications: one case of hyperemesis gravidarum, one of preeclampsia, and one of threatened preterm labor secondary to polyhydramnios. Except for one, all deliveries were performed via cesarean section for obstetric indications, resulting in live, healthy neonates. Four births were preterm, with low-birth-weight infants.

In our experience, pregnancies in simultaneous pancreas-kidney transplantation recipients were associated with favorable maternal and fetal outcomes. Careful planning and close multidisciplinary monitoring by nephrology, endocrinology, and obstetrics are essential to optimize results during pregnancy.