Renal allograft and patient survival not compromised by pregnancy

By Paula Moyer

NEW YORK (Reuters Health) – Neither the allograft nor patient survival is compromised when a renal transplant patient becomes pregnant, according to Dr. Alan Buchbinder, speaking last week in New Orleans at the 22nd annual meeting of the Society for Maternal-Fetal Medicine.

"We had long-term follow-up of matched cohorts in three groups: women who had become pregnant, women who had not been pregnant, and men," Dr. Buchbinder told Reuters Health. "Although some physicians might be surprised by these findings, they showed that pregnancy does not have a deleterious effect on either the allograft or patient survival."

Dr. Buchbinder, a staff perinatologist at Hennepin County Medical Center in Minneapolis, said that females had greater longevity after transplantation, regardless of posttransplant parity, when compared with their male counterparts. The investigative team drew their data from a renal transplant database at the University of Cincinnati.

Dr. Buchbinder and his colleagues followed 23 women who had had at least one pregnancy following transplantation, 26 women who had not been pregnant after transplantation, and 23 male transplant patients. The subjects were followed prospectively after their transplants, which took place between 1980 and 1987.

Among the 23 pregnant patients, there was a 22% mortality rate, compared with mortality rates of 23% and 61% for the nonpregnant women and the men, respectively. Graft survival rates were 56% for the pregnant group, 58% for the nonpregnant women, and 30% for the men. Graft failure rates were 30% for the pregnant group, 31% for the nonpregnant women, and 30% for the men.

Other research presented at the meeting investigated diverse aspects of pregnancy and renal transplantation.

In a single-site study based in Seoul, Korea, investigators found that successful pregnancy following renal transplant was feasible, but the risk of certain complications was high. Dr. Yongwon Park and colleagues retrospectively reviewed the outcomes of 47 pregnancies in 36 renal transplant patients.

Among the patients there were 25 deliveries, 13 at term and 12 preterm. The mean birth weight was 2260.8 g, with a mean gestational age of 36.9 weeks. Sixteen of the deliveries were by Cesarean section. There were 18 induced and 4 spontaneous abortions.

Fetal growth restriction complicated 19 of the 25 deliveries. Among these patients, 13 had hypertension, with 5 cases of aggravated hypertension.

The results of another study, based on data from the National Transplantation Pregnancy Registry (NTPR), indicated that pregnancies among patients maintained on tacrolimus have fared relatively well, although continued monitoring was recommended.

Dr. Amy Levine, at Hahnemann University in Philadelphia, and colleagues followed 34 pregnancies in 26 renal transplant recipients. Among these patients, seven had spontaneous abortions, and one underwent an elective termination of pregnancy; there was one stillbirth.

The mean gestational age at delivery was 34.0 weeks. There were 15 preterm deliveries, including 7 before 32 weeks. The mean birth weight was 2088 g; seven infants had birth weights below the 10th percentile. Eleven of the mothers developed pre-eclampsia.

Of particular concern was a twin gestation that resulted in the neonatal death of one twin. The twins were delivered at 32 weeks because of severe pre-eclampsia. Both infants were diagnosed with cardiomyopathy and congestive heart failure. One twin died 5 days after birth; these conditions resolved with medical management in the other twin. The investigators believe this case underscores the continued need for the NTPR database, so any patterns of tacrolimus-related adverse events can be identified.

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