A case of pregnancy after kidney transplantation: preconception care management in collaboration with the urologist

Abstract

 Pregnancy after kidney transplantation has several risks of perinatal complications such as hypertensive disorders of pregnancy, antibody-mediated rejection, and deterioration in allograft function. However, pregnant patients after kidney transplantation can have safe pregnancy and childbirth if their conditions were appropriately managed. Regarding perinatal management, it is necessary to consider the impact of pregnancy on transplanted kidney and risk of perinatal complications. Herein, we report a successful case of pregnancy after kidney transplantation which was managed by preconception care in collaboration with the urologist. The patient was a 34-year-old primiparous woman. At the age of 31, she underwent a living kidney transplantation due to hypoplastic kidney. She visited our hospital for preconception care. The urologist performed a renal biopsy and changed her immunosuppressive drugs into appropriate agents used during pregnancy. In this period, we obstetrician informed her of the perinatal risks of pregnancy after kidney transplantation and she fully understood them. Following these discussions, we approved her pregnancy, and she subsequently became pregnant. She developed gestational hypertension syndrome at 30 weeks’ gestation. We managed her hypertension by methyldopa and discussed her delivery timing with the urologist. We decided her termination criteria to be serum creatinine level > 2.0mg/dl. Her blood pressure was elevated to 162/102mmHg. An emergency cesarean section was performed at 35 weeks of pregnancy. Maternal blood pressure and kidney function recovered to the same level as before pregnancy one month after childbirth. Pregnancy after kidney transplantation may lead to graft loss after childbirth. Careful consultation with related departments was necessary for providing preconception care and determining delivery time.