Di Loreto P, Martino F, Chiaramonte S, Dissegna D, Ronco C, Marchesoni D, Catapano P, Romano G, Montanaro D
Nephrology Dialysis Transplantation San Bortolo Hospital, Vicenza, Italy.
Transplant Proc. 2010 May;42(4):1158-61. doi: 10.1016/j.transproceed.2010.03.082.
Pregnancy after kidney transplant has become possible thanks to the recent surgical and pharmacological breakthrough.
We performed a retrospective study including all childbearing women transplanted in our centers after 1997. The following variables were analyzed: type of nephropathy, patient age when dialysis started, age at transplantation, time between dialysis and transplantation and between transplantation and baby birth. We also considered immunosuppressive therapy, type of delivery, baby weight, Apgar score, and mother and baby follow-up.
We followed up 13 pregnancies in 12 patients who were diagnosed with chronic pyelonephritis (n = 4), postpartum cortical necrosis (n = 1), immunoglobulin A GN (n = 4), diabetic nephropathy (n = 1), unknown nephropathy (n = 2). All patients received a cadaveric donor kidney. They were treated with calcium antagonists and alfamethyldopa for their high blood pressure. We observed 9 mother complications: nonnephrotic proteinuria (n = 1), urinary tract Infection (n = 1), pre-eclampsia (n = 4), internal placenta detachment (n = 1) and spontaneous abortions (n = 2); 4 fetal complications: IUGR (n = 2), acute distress respiratory syndrome (n = 1), Klinefelter syndrome (n = 1) and preterm births (n = 4). In 2 cases the child weight was lower when compared to the gestational age, and 5 babies were admitted to the neonatal intensive care unit. The mother's follow-up showed no acute rejection episodes. Breastfeeding was discouraged due to the transmission of immunosuppressive medications into breast milk. We did not observe significant disease upon child follow-up.
Our data were in agreement with the literature confirming that pregnancy after kidney transplant though possible carries elevated risks. Patients therefore are referred to highly specialized centers where obstetricians, nephrologists, intensivists, and neonatologists provide surveillance and treatment.
由于近期手术和药理学上的突破，肾移植后怀孕已成为可能。
我们进行了一项回顾性研究，纳入了1997年后在我们中心接受移植的所有育龄妇女。分析了以下变量：肾病类型、开始透析时的患者年龄、移植时的年龄、透析与移植之间以及移植与婴儿出生之间的时间。我们还考虑了免疫抑制治疗、分娩类型、婴儿体重、阿氏评分以及母婴随访情况。
我们对12例患者的13次妊娠进行了随访，这些患者被诊断为慢性肾盂肾炎（n = 4）、产后皮质坏死（n = 1）、免疫球蛋白A肾小球肾炎（n = 4）、糖尿病肾病（n = 1）、不明肾病（n = 2）。所有患者均接受了尸体供肾。她们因高血压接受了钙拮抗剂和甲基多巴治疗。我们观察到9例母亲并发症：非肾病性蛋白尿（n = 1）、尿路感染（n = 1）、先兆子痫（n = 4）、胎盘早剥（n = 1）和自然流产（n = 2）；4例胎儿并发症：宫内生长受限（n = 2）、急性呼吸窘迫综合征（n = 1）、克兰费尔特综合征（n = 1）和早产（n = 4）。2例患儿体重低于孕周，5例婴儿入住新生儿重症监护病房。母亲的随访显示无急性排斥反应发作。由于免疫抑制药物可通过母乳传播，不鼓励母乳喂养。对儿童的随访未发现明显疾病。
我们的数据与文献一致，证实肾移植后怀孕虽有可能，但风险较高。因此，患者应转诊至高度专业化的中心，由产科医生、肾病学家、重症监护医生和新生儿科医生进行监测和治疗。
