Pregnancy in renal transplant recipients

Fertility is considerably affected in chronic renal insufficiency and periodic hemodialysis, and it is improved by renal transplantation. Transplanted patients recover from their renal failure state, and pregnancy occurred in 2% renal graft recipients who were fit to procreate. The aim of this study was to bring back the cases of pregnancies carried out in our renal patients who had transplantation surgery and to specify the possible complications of the foetus before and after the childbirth. It is a retrospective study with records of 20 years period (1986 to 2006) of 10 pregnancies which occurred in 7 renal transplant recipients in our Charles Nicole hospital department. Mean patient age was 33.8 years (29 to 43 years). Mean time between transplantation and the onset of pregnancy was 6.5 years (1 to 18 years). Before pregnancy, hypertension was observed in 1 case and proteinuria in other case. All our patients had creatininemia <1.50 mg/dl. Immunosuppressive treatment associated steroids and azathioprin in 3 cases, steroids and ciclosporin A in 2 cases and steroids, ciclosporin A and azathioprin in 2 cases. One patient developed diabetes. Maternal complications were rare, essentially hypertension in 2 cases, proteinuria in 1 case, ascension of creatininemia in 2 cases and hepatic cholestase in 2 cases. Prematurity was observed in 2 cases; it was related to premature rupture of membranous in 1 case and uterine contractions in cesarean patient in other case. The mean neonatal weight was 2950 g (2100 to 3500 g) with 4 small gestational age (< 2800 g). It was noted in 1 case of newborn, down's syndrome in a pregnant women who was 37 years. After a mean follow up of 7.4 years follow-up, mean cretininemia was 1.80 mg /dl (0.74-5.53 mg /dl). One patient showed chronic rejection. Immunosuppressive treatment seemed without adverse effects on fetus. The only case of chromosome abnormality appeared in a pregnant women who was more than 35 years old. The course of pregnancy after renal transplantation is generally uncomplicated without increased risk of graft loses. However, a normal arterial pressure, a stable renal function and absence of proteinuria were requested before allowing a pregnancy.