Pregnancy in kidney transplanted women: What are the optimal conditions for a better pregnancy outcome?

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Published Jan 30, 2015
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Vol. 92 No. 8 (2014): Issue Aug 2014

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Ben Haj Hassine Amine
Siala Haythem
Basly Mohamed
Harzallah Kais
Chibani Mounir
Rachdi Radhouane

Abstract

Background: Motherhood has long been not recommended for kidney transplanted women for fear of adverse effects on the graft and the risks to the fetus.

Aims: This article aimed to provide evidence based answer to the following questions regarding pregnancy in kidney transplanted women: 1. what are the nephrologic and obstetrical parameters that can influence the pregnancy outcome? 2. What is the impact of pregnancy on graft? 3. What are the optimal conditions for pregnancy planning in kidney transplanted women?

Methods: A literature search was conducted using as key words “pregnancy”, “renal transplant”, “renal graft survival” in the PubMed database over the period from January 1994 to December 2011. Results: Recovery of renal function in kidney transplanted patients is followed by restoration of endocrine function. Knowledge of the initial nephropathy assesses the risk of recurrence after transplantation, which may affect the graft. Chronic glomerular nephropathies are the most frequent from 32 to 76.1%. Duration of hemodialysis (over 2 years) is associated with a risk of preterm delivery and growth retardation. A period of 1 year between renal transplantation and conception seems reasonable to stabilize renal function and reduce the doses of immunosuppressants. The number of unintended pregnancies remains high (50%). The incidence of pregnancy after renal transplantation varies between 3 and 21.2%. Graft survival in patients who carried a pregnancy is equivalent to that of patients who were not pregnant.

Conclusions: Pregnancy in kidney transplanted patients is a highrisk pregnancy, but it does not seem to affect graft function through certain conditions.

Keywords:

Renal graft, pregnancy, pre-eclampsia, prematurity.

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References

  1. Gill JS, Zalunardo N, Rose C, Tonelli M. The pregnancy rate and live birth rate in kidney transplant recipients. Am J transplant 2009;9:1541-9.
  2. Areia A, Galvao A, Pais MS, Freitas L, Moura P. Outcome of pregnancy in renal allograft recipients. Arch Gynecol Obstet 2009;279:273-7.
  3. Kim HW, Seok HJ, Kim TH, Han DJ, Yang WS, Park SK. The experience of pregnancy after renal transplantation: Pregnancies even within postoperative 1 year may be tolerable. Transplantation 2008;85:1412-9.
  4. Kurata A, Matsuda Y, Tanabe K, Toma H, Ohta H. Risk factors of preterm delivery at less than 35 weeks in patients with renal transplant. Eur J Obstet Gynecol Reprod Biol 2006;128:64-8.
  5. Yildirim Y, Uslu A. Pregnancy in patients with previous successful renal transplantation. Int J Gynaecol Obstet 2005;90:198-202.
  6. Ehrich JH, Loirat C, Davison JM et al. Repeated successful pregnancies after kidney transplantation in 102 women (reported by the EDTA Registry). Nephrol Dial Transplant 1996;11:1314-7.
  7. Rahaminov R, BenHaroush A, Wittenberg C et al. Pregnancy in renal transplant recipients: Long Term effect on patient and graft survival. A single-center experience. Transplantation 2006;81:660-4.
  8. Kashanizadeh N, Nemati E, Sharifi-Bonab M et al. Impact of pregnancy on the outcome of kidney transplantation. Transplant Proc 2007;39:1136- 8.
  9. Davison JM, Milne JE. Pregnancy and renal transplantation. Br J Urol 1997;80:29-32.
  10. Wolfe RA, Ashby VB, Milford EL et al. Comparison of mortality in all patients on dialysis, patients on dialysis awaiting for transplantation and recipients of a first cadaveric transplant. N Engl J Med 1999;341:1725- 30.
  11. Laupacis A, Keown P, Pus N et al. A study of the quality of life and costutility of renal transplantation. Kidney Int 1996;50:235-42.
  12. Winkelmayer WC, Weinstein MC, Mittleman MA, Glynn RJ, Pliskin JS. Health economic evaluations: The special case of end-stage renal disease treatment. Med Decis Making 2002;22:417-30
  13. Keitel E, Bruno RM, Duarte M et al. Pregnancy outcome after renal transplantation. Transplant Proc 2004;36:870-1.
  14. Cruz Lemini MC, Ochoa FI, Villanueva Gonzalez MA. Perinatal outcome following renal transplantation. Int J Gynaecol Obstet 2007;96:76-9.
  15. Basaran O, Emiroglu R, Seçme S, Moray G, Haberal M. Pregnancy and renal transplantation. Transplant Proc 2004;36:122-4.
  16. Gorgulu N, Yelken B, Caliskan Y, Turkmen A, Sever MS. Does pregnancy increase graft loss in female renal allograft recipients? Clin Exp Nephrol 2010;14:244-7.
  17. Ben Aissia N, Battar S, Gara MF. Les particularités de la grossesse et de l'accouchement après greffe rénale. Tunis Med 2003;81:55-8.
  18. Ducarme G, Ceccaldi PF, Toupance O, Graesslin O, Rieu P, Gabriel R. Grossesse après transplantation rénale. Suivi obstétrical et retentissement sur le greffon rénal. Gynecol Obstet Fertil 2006;34:209-13.
  19. Ghanem ME, El-Baghdadi LA, Badawy AM, Bakr MA, Sobe MA, Ghoneim MA. Pregnancy outcome after renal allograft transplantation: 15 years experience. Eur J Obstet Gynecol Reprod Biol 2005;121:178- 81.
  20. Armenti VT, Daller JA, Constantinescu S et al. Report from the National Transplantation Pregnancy Registry: outcomes of pregnancy after transplantation. Clin Transplant 2006:57-70.
  21. McKay DB, Josephson MA, Armenti VT et al. Reproduction and transplantation: Report on the AST Consensus Conference on Reproductive Issues and Transplantation. Am J Transplant 2005;5:1592-9.
  22. Sibanda N, Briggs D, Davison JM, Johnson RJ, Rudge CJ. Pregnancy after organ transplantation: a report from the U.K.Transplant Pregnancy Registry. Transplantation 2007;83:1301-7.
  23. Sibanda N, Briggs D, Davison JM, Johnson RJ, Rudge CJ. Pregnancy after organ transplantation: a report from the U.K.Transplant Pregnancy Registry. Transplantation 2007;83:1301-7.transplantation. J Am Soc Nephrol 1994;4:30-6
  24. Haas M, Mayer G. Cyclosporine Associated hypertension: pathomechanisms and clinical consequences. Nephrol Dial Transplant 1996;12:395-8.
  25. Davison JM, Bailey DJ. Pregnancy following renal transplantation. J Obstet Gynaecol Res 2003;29:227-33
  26. Aivazoglou L, Sass N, Silva Jr HT, Sato JL, Medina-Pestana JO, De Oliveira LG. Pregnancy after renal transplantation: an evaluation of the graft function. Eur J Obstet Gynecol Reprod Biol 2011;155:129-31.
  27. Fuchs KM, Wu D, Ebcioglu Z. Pregnancy in renal transplant recipients. Semin Perinatol 2007;31:339-47.
  28. Sturgiss SN, Davison JM. Effect of pregnancy on the long-term function of renal allografts: an update. Am J Kidney Dis 1995;26:54-6.
  29. First MR, Combs CA, Weiskittel P, Miodovnik M. Lack of effect of pregnancy on renal allograft survival or function. Transplantation 1995;59:472-6.
  30. Armenti VT, Radomski JS, Moritz MJ, Philips LZ, McGrory CH, Coscia LA. Report from the National Transplantation Pregnancy Registry (NTPR): Outcomes of pregnancy after transplantation. Clin Transplant 2000:123-34.
  31. Nulman I, Sgro M, Barrera M, Chitayat D, Cairney J, Koren G. Long-term neurodevelopment of children exposed in utero to ciclosporin after maternal renal transplant. Pediatr Drugs 2010;12:113-22.