PREGNANCY AFTER RENAL TRANSPLANTATION

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Abstract
During the 13 yr period 1971-1984 there were 38 pregnancies in 21 renal transplant patients at the Johannesburg Hospital [South Africa]. Twenty-two ended with live births and included 2 sets of twins; there were 9 spontaneous abortions, 6 therapeutic abortions and 1 stillbirth. Maternal complications were mild in the majority but 5 patients suffered deterioration in renal function, 2 undergoing transplant nephrectomy as a result of this. There were 7 neonatal deaths, including both sets of twins; death was due to prematurity in 6 and congenital malformation (diaphragmatic hernia) in 1. A further infant had congenital pyloric stenosis which was corrected surgically. Pregnancies were analyzed according to whether or not their outcome was successful. Those with a successful outcome had less exposure to warfarin during pregnancy (P = 0.0025) and showed a tendency towards lower immunosuppressive doses of prednisone and azathioprine although these did not reach significance. Although these results indicate an unhappy prognosis for both the mother and fetus, 2 redeeming features are to be noted. Pregnancy outcome improved markedly in the latter years, possibly owing to non-exposure to warfarin, less immunosuppression, and improvement in neonatal care and 4 of the 5 mothers who suffered deterioration in renal function were notoriously uncooperative in their medical care. Pregnancy can only be recommended in the transplanted patient who had stable renal function, is compliant in taking of medications and whose graft is of such age that the immunosuppressive drug dose in minimal. Warfarin should be avoided.

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