Pregnancy after renal transplantation in Italian patients: Focus on fetal outcome

Background. In the last few years advances in surgical techniques and immunosuppression have improved not only survival, but also quality of life in organ transplanted patients. Hence, the number of women of child-bearing age who decide to have a child - which means resuming a normal life - has increased. This multicenter retrospective study describes pregnancies after kidney transplantation and is the first such survey in Italy. Methods. We analyzed the outcomes from 56 pregnancies in 42 kidney transplant recipients from data collected in questionnaires, hospital records, and phone interviews. All recipients were maintained on cyclosporine (CsA), azathioprine (AZA), corticosteroids or tacrolimus (FK506) before and during pregnancy. Results. The average time from transplantation to childbirth was 62 months (range 12 to 180). Complications arose during pregnancy in 16 out of 36 term pregnancies (44.4%). Four transplant rejections (11.8%) were documented, two of them irreversible. Thirty-six infants were born, and 20 abortions reported (35.7%). Of these 36 babies, 16 (44.4%) were born at term, and 20 (55.6%) before term. Thirty-three Cesarean sections were performed (91.7%). Among the 20 pre-term babies, 11 can be grouped as follows: 5 low-birth-weight (LBW) (13.9%), 4 very low-birth-weight (VLBW) (8.3%) and 2 extremely very low-birth-weight (EVLBW) (5.6%). The children were followed up for periods ranging from 2 months to 13 years. Conclusions. In kidney transplant recipients who became pregnant the incidence of spontaneous abortion and preterm delivery was increased. Newborns delivered to these patients had low birth weight, but no congenital defects were noted and their development was normal.