Obstetric Outcome after Renal Transplantation / 대한산부인과학회잡지

ABSTRACT

OBJECTIVE: To evaluate the outcome of pregnancy in kidney transplanted women, and correlate this with the time of transplantation to conception. MATERIAL AND METHODS: We analyzed the outcome of 31 pregnancies from 21 allograft recipients at Kangnam St. Mary's Hospital, Catholic Medical Center from January 1990 through December 2000. For each reported pregnancy we reviewed obstetrical, medical and pediatric records. For children follow-up and for those whose obstetric procedures were taken in other hospitals, we did a questionarie and telephone interviews. RESULTS: Of the 31 pregnancies followed by us, there were 23 live-born offspring delivered by 21 mothers and 8 stillborn/abortuses, including five artificial abortuses. The mean gestational age at delivery was 36.18+/-0.6 weeks and the mean birth weight of the offspring was 2,525+/-137gm. Only 43.4% was delivered after 37weeks of gestation. Preterm delivery rate (delivered before 37weeks of gestation) was 56.5%. Common obstetric complications were intrauterine growth restriction (39.1%) preterm labor (35%), premature rupture of membrane (30%), preeclampsia (30%), and maternal complications were deterioration of renal function (5%) and rejection of allograft (18%) after delivery. Mean interval from transplantation to pregnancy was 4.7 years. Twelve pregnancies occurred within the first 2 years of transplantation, while 19 pregnancies occurred after that period. No difference was noted in neonatal body weight between 2 groups (p=0.824). There was no difference in mean interval from transplantation to pregnancy in the delivery group (5.21+/-0.9 years) vs. the abortion group (4.57+/-1.1 years) (p=0.207). All women continued with her medication during pregnancy, based on cyclosporine and/or azathioprine and steroids. No congenital anomaly was noted in the newborn. When follow up lately, one boy with neurofibromatosis and a girl with recurrent hematuria were noted. CONCLUSION: Although pregnancy in renal allograft patient is hazardous, good outcome can be expected if function of the allograft is good before conception.