Kidney transplantation gives rebirth to patients who suffer from End Stage Kidney failure. Women who are in their reproductive age, and suffer from ESRD (End Stage Kidney Disease) are understandably eager to conceive once they get a successful kidney transplantation. While on dialysis, women experience menstrual irregularities, ovulation failure, decreased libido and hormonal irregularities that significantly reduce the incidence of pregnancy during dialysis. After successful transplantation, these abnormalities normalize and women regain these functions.
Challenges in Post-Transplant Pregnancy:
However, pregnancy post-transplant has its own challenges. Side effects of immunosuppressive medications, risk of deteriorating graft function, increased risk of hypertension during pregnancy (Pre-eclampsia and Eclampsia) in the mother, increased fetal risks that include abortions, low birth weight babies, pre-mature delivery, congenital abnormalities in children are challenges faced.
Hence, proper counselling of the couple and careful monitoring is essential during pregnancy. A team approach involving the nephrologist, obstetrician, and neonatologist is key to a successful outcome.
Increased Infection Risk in Pregnancy
There is a high risk of Urinary Tract Infection (UTI) during pregnancy. Regular screening for pus cells or bacteria in the urine is mandatory. Even if the woman is asymptomatic, UTI to be treated with appropriate antibiotics. Apart from UTI, there are other infections like Cytomegalovirus infection that could not only affect the mother but also the unborn child.
Predictors of Pregnancy Outcome
It is generally advisable to wait at least one year before attempting pregnancy post-transplant. This time is needed to ensure that the kidney functions well and adapts to the recipient’s immune system. Post-kidney transplant complications, such as rejection or infections, are more common in the first year. Additionally, the dose of immunosuppressive medications is higher initially and is reduced to a minimum by one year.
Normal kidney function (with a creatinine of < 1.5 mg/dl) minimal proteinuria ( < 500 mg/day) well-controlled blood pressure with one or a maximum of two medications are safe . Also drugs like mycophenolate and sirolimus should be stopped at least 6 – 8 weeks before conception. Cyclosporin / tacrolimus, Azathioprine, and Steroids that are regularly used to protect the kidney from rejection are safe to continue during pregnancy.
Case History: 25-year-old Ms. V presented with ESRD, underwent dialysis for a brief period, and received a kidney donation from her mother. She did well post-transplant, got married, and was counselled for pregnancy. Her medications were suitably modified, and she subsequently became pregnant, delivering a healthy male child by Caesarean section. The entire pregnancy was closely monitored, and both mother and child remained healthy and incident-free.
Dr. R. Balasubramaniyam
Chief Nephrologist
Kauvery Hospital Chennai
