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

Between January 1958 and December 1992, 136 kidney transplants were pe rformed in the University Hospital of Ribeirao Preto, with women of ch ildbearing age (14 to 40 years) as receptors, From this population, 19 patients became pregnant at least once after transplantation, and 2 w ere transplanted inadvertently during the first trimester of their pre gnancies, There was a total of 25 pregnancies and 27 offspring, The me an 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, Ther e were two miscarriages (8%) and two therapeutic abortions (8%); of th ose 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 pr ematurity (gestation < 37 weeks) of 57%, and their offspring weighed f rom 670 to 3,100 g (mean, 2,236 g), presenting a very high incidence o f low birthweight (64%), There was one stillborn and one neonatal deat h, The most common complications that occurred during pregnancy were i nfections (especially urinary tract and vaginal mycotic infections) fo llowed by hypertension. The obstetric complications were distributed a s follows: premature rupture of membranes in 27%, fetal distress in 24 %, preterm labor in 24%, and oligohydramnios in 10%. Lower segment ces arean section was necessary in 16 of 21 cases (75%), and all were for obstetric reasons. One patient died during the puerperium because of s epsis, No patient had any rejection episode or graft loss. Excluding t he two patients that were already pregnant at the time of transplantat ion, 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 prio r values after delivery (median, 0.9 mg/dL; range, 0.6 to 1.7). In a c ase control study, there was no difference in patient or graft surviva l, 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 p atient survival. The two patients that were transplanted in their firs t trimester of pregnancy received, as usual, high doses of immunosuppr ession 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 a fter transplantation to become pregnant, and is closely followed by a multidisciplinary group. (C) 1995 by the National Kidney Foundation, I nc,