Pregnancy Outcomes After Renal Transplantation: A Retrospective Case Series

Objective: To investigate the clinical characteristics and outcomes of pregnancies after renal transplantation (RT). Materials and Methods: A retrospective study was employed. Data of obstetric, transplantation, pregnancy outcomes, and maternal and neonatal complications from 2000 to 2017 were obtained from a single obstetrics center. Results: Eleven cases of pregnancies were included: the mean age at conception was 31.27 ± 3.44 (26–36, median 32) years and interval from RT to pregnancy was 51.18 ± 30.65 (25–132, median 38) months. The nine successful pregnancies (9/11) were all in women who maintained their immunosuppressive regimens. All infants were delivered by cesarean section for severe pre-eclampsia in eight cases and placental abruption in one case at a mean gestational age of 34.67 ± 1.41 (30–38) weeks and a median birth weight of 2374.56 ± 569.00 (1,325–3,070) g. Four of nine infants had low birth weight, and six of nine infants underwent premature delivery. The babies had no postpartum complications or congenital anomalies at follow-up period (12–180 months, mean 98.18 ± 54.73 months). One infant was transferred to the neonatal intensive care unit for neonatal asphyxia. Nine cases were uncomplicated at the first trimester, but developed severe pre-eclampsia after the second trimester. Two patients had allograft dysfunction from the second trimester and delivered at the third trimester, and then lost the allografts at 2 and 6 years postdelivery, respectively, whereas the other seven patients had well-functioning allografts at an average follow-up of 108 months. Two patients who decreased their immunosuppressive regimens and developed severe complications had second trimester therapeutic abortion and lost their allografts Conclusions: During pregnancy, RT patients exhibit risks for the mother, fetus, newborn, and allograft. Decreasing immunosuppressors leads to poor outcomes. With proper peritransplant and periconceptional counseling, these patients can have acceptable pregnancy outcomes.