Pregnancy in renal transplantation. Clinical aspects

Following renal transplantation, it is often possible to achieve parenthood. If a female recipient becomes pregnant she must be considered at high risk and so monitored. The better the renal function before pregnancy, the more satisfactory the obstetric outcome. Pregnancy in transplanted mothers presents many complex medical problems and is related to definite risks to both mother (toxemia, serious infections) and fetus (intrauterine growth retardation, premature labor). If a renal function is compromised prior to conception and there is a further deterioration during pregnancy, termination of pregnancy or premature delivery should be considered to avoid permanent impairment of renal function. Pregnancy is regarded as an immunologically privileged state and that is the reason why the incidence of rejection in pregnant patients is unusual. Rejection occasionally occurs in puerperium. Immunosuppressive drugs must be continued during pregnancy to maintain the integrity of the transplanted kidney. There are no predominant or frequent developmental abnormalities in children of renal transplanted recipients treated with modest doses of immunosuppressive and steroid drugs. Usually the transplanted kidney does not produce any mechanical dystocia in labor and during vaginal delivery there is no apparent mechanical injury to the kidney. Cesarean section is usually necessary for purely obstetric reasons. The possibility of conception in kidney transplants recipients of childbearing age and the fact that pregnancy is not without significant maternal and fetal risks emphasizes the need for counseling, with regard to family planning, all such patients.