PREGNANCY AND KIDNEY-TRANSPLANTATION - EXPERIENCE IN A DEVELOPING-COUNTRY

Between January 1958 and December 1992, 136 kidney transplants were performed in the University Hospital of Ribeirao Preto, with women of childbearing age (14 to 40 years) as receptors, From this population, 19 patients became pregnant at least once after transplantation, and 2 were transplanted inadvertently during the first trimester of their pregnancies, There was a total of 25 pregnancies and 27 offspring, The mean age at the time of conception was 28.6 years (23 to 41 years), with a mean interval of 3.5 years from transplant to conception (<1 to 16 years), All patients continued their immunosuppressive regimens during the entire pregnancy, but only 5 of 25 were taking cyclosporine, There were two miscarriages (8%) and two therapeutic abortions (8%); of those that passed the 20th week of pregnancy, the mean gestation time at delivery was 35 weeks (range, 28 to 38 weeks) with an incidence of prematurity (gestation < 37 weeks) of 57%, and their offspring weighed from 670 to 3,100 g (mean, 2,236 g), presenting a very high incidence of low birthweight (64%), There was one stillborn and one neonatal death, The most common complications that occurred during pregnancy were infections (especially urinary tract and vaginal mycotic infections) followed by hypertension. The obstetric complications were distributed as follows: premature rupture of membranes in 27%, fetal distress in 24%, preterm labor in 24%, and oligohydramnios in 10%. Lower segment cesarean section was necessary in 16 of 21 cases (75%), and all were for obstetric reasons. One patient died during the puerperium because of sepsis, No patient had any rejection episode or graft loss. Excluding the two patients that were already pregnant at the time of transplantation, all had normal prior values of serum creatinine before pregnancy (median, 1.0 mg/dL; range, 0.5 to 1.5), which in most decreased during pregnancy (median, 0.8 mg/dL; range, 0.4 to 1.3) and returned to prior values after delivery (median, 0.9 mg/dL; range, 0.6 to 1.7). In a case control study, there was no difference in patient or graft survival, with a mean of 8.2 +/- 1.13 years (control group: 7.5 +/- 1.06) for the graft and 8.3 +/- 1.16 years (control group: 8.05 +/- 1.12) for patient survival. The two patients that were transplanted in their first trimester of pregnancy received, as usual, high doses of immunosuppression drugs and presented an outcome that was similar to the others, These data indicate that pregnancy after renal transplantation can be safe if the patient has normal renal function, waits at least 1 year after transplantation to become pregnant, and is closely followed by a multidisciplinary group. (C) 1995 by the National Kidney Foundation, Inc,