Women after transplantation do better with pregnancy than those with end-stage renal disease receiving dialysis (Saliem, 2016). In one review of 2000 pregnancies in transplant recipi ents, most were treated with cyclosporine and tacrolimus, and approximately 75 percent of pregnancies resulted in a live birth (Coscia, 2010). Studies from other countries describe similar outcomes (Bramham, 2013; Wyld, 20l3). In a study from
Uruguay, 62 percent of liveborns were preterm (Orihuela, 2016). Two other reports also cited a high prevalence of pre term delivery (Erman Akar, 2015; Stoumpos, 2016). Notably, the incidence of fetal malformations was not increased, except in those who took mycophenolate mofetil (Coscia, 2010).
The incidence of preeclampsia is increased in all transplant recipients (Brosens, 20l3). In the UK National Cohort Study, the incidence of preeclampsia was 22 percent (Bramham, 2013). From their review, Josephson and McKay (2011) cite an incidence of a third of pregnancies but question the validity of this frequency. Importantly, in some cases, rejection is difficult to distinguish from preeclampsia. hat said, the incidence of rejection episodes approximates 2 to 5 percent (Bramham, 2013; Orihuela, 2016). Viral infections-especially those by poyomavirus hominis 1, also called BK virus, are frequent. In kidney transplant recipients, this virus can cause nephropathy and graft loss, and afected patients generally have an asymptomatic decline in renal function (Wright, 2016). Gestational diabetes is also found in approximately 5 percent of transplant recipients. Both are likely related to immunosuppression therapy. Similar outcomes are reported by other investigators (Al Duraihimh, 2008; Cruz Lemini, 2007; Ghafari, 2008).
Several requisites should be satisfied by renal transplantation patients before attempting pregnancy G osephson, 2011; Lopez, 2014). First, women should be in good general health for at least 1 to 2 years after transplantation. Also, renal function should be stable and without severe renal insuiciency. Thus, serum creatinine is <2 mg/dL and preferably < 1.5 mg/ dL, and proteinuria is <500 mg/d. Evidence for graft rejection should be absent for 6 months, and pyelocalyceal distention by urography should not be seen. Moreover, hypertension should be absent or well controlled. And last, women should be taking no teratogenic drugs, and drug therapy should be reduced to maintenance levels.
Cyclosporine, tacrolimus, prednisone, and azathioprine are given routinely to renal transplantation recipients Gain, 2004; Lopez, 2014). Cyclosporine blood levels decline during pregnancy, although this was not reported to be associated with rejection episodes (Akturk, 2015; Kim, 2015). Unfortunately, these agents are nephrotoxic and also may cause renal hypertension. In fact, they likely contribute substantively to chronic renal disease that develops in 10 to 20 percent of patients with nonrenal solid-organ transplantation (Goes, 2007). Concern persists regarding the possible late efects in ofspring subjected to immunosuppressive therapy in utero. hese include malig nancy, germ cell dysfunction, and malformations in the chil dren of the ofspring. In addition, cyclosporine is secreted in breast milk (Moretti, 2003).