Pregnancy after Renal Transplantation

Background: Pregnancies in renal transplant recipients continue to remain challenging due to the risks to graft, fetus and mother. This is a retrospective case-note review aiming to identify graft, fetal and maternal outcomes in such pregnancies. Aim:?Identification of maternal, fetal and graft outcomes of pregnancies in renal transplant recipients. Methods: This is a retrospective study of pregnancies in renal transplant recipients over ten years in a tertiary care hospital. Medical records were reviewed for maternal outcomes (hypertension, gestational diabetes, anemia, infections, Caesarean section), fetal outcomes (therapeutic abortions, miscarriages, prematurity, low birth weight), and effect of pregnancy on allograft function. During the study period there were twelve pregnancies in women with renal transplant. Results: There were eight live births with healthy babies. Median age at conception was 28 years. 58.3% of women had preexisting hypertension and the overall incidence of hypertension was 83.3%. One woman developed gestational diabetes. 50% of pregnancies were complicated by antenatal infections and anaemia was found in 50% of patients. 65.5% needed a Caesarean section. The incidence of preterm delivery was 55.5%. 33% of babies were small for gestational age. There were two first-trimester miscarriages, one second-trimester miscarriage and an iatrogenic preterm delivery at 26 weeks. All women had a stable renal function at conception. A decline in graft function was observed in 33.3% of patients and there were no cases of acute rejection. Conclusion: Most pregnancies after kidney transplantation are successful but rates of maternal and neonatal complications remain high. Significant causes of morbidity in this study were hypertension, prematurity and fetal growth restriction. Our study reaffirms the need for multidisciplinary care in patients living with renal transplant because of the increased risk of maternal and fetal complications.