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Liu C, Li YJ, Wu HH, Wu HM, Tian YC. Successful Twin Delivery Through In Vitro Fertilization in a High-Gestation Age Kidney Transplant Recipient: A Case Report. Transplant Proc 2024; 56:742-745. [PMID: 38519267 DOI: 10.1016/j.transproceed.2024.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 02/26/2024] [Indexed: 03/24/2024]
Abstract
BACKGROUND Numerous successful pregnancy outcomes have been reported after kidney transplantation, but until now, there have been no reports of healthy twin deliveries through in vitro fertilization treatment in high-gestation aged women with a long post-transplant duration. In our report, we present a case of a high-gestation aged kidney transplant recipient who successfully delivered healthy twins with the aid of in vitro fertilization. CASE PRESENTATION At the age of 29, a woman with end-stage kidney disease caused by immunoglobin A nephropathy underwent kidney transplantation. She had a history of premature ovarian failure and had been on continuous ambulatory peritoneal dialysis since the age of 18. Eleven years after starting dialysis, she received a cadaveric kidney transplant. Despite being infertile for 7 years after transplantation, she wished to have children. In vitro fertilization embryo transfer was conducted after failure of ovarian stimulation, considering her age and premature ovarian failure. The patient successfully delivered twins at 29 weeks gestation via cesarean section, as the first fetus presented in breech position. The first newborn weighed 945 g and the second weighed 855 g, with no other congenital abnormalities found. One year after childbirth, neither the recipient nor her babies experienced any fatal complications. CONCLUSIONS A woman who underwent kidney transplantation and has stage 3 CKD may successfully deliver healthy twins through in vitro fertilization embryo transfer, even if she is of advanced maternal age and has a long post-transplant period. However, there is a risk of preterm premature rupture of membrane in such cases.
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Affiliation(s)
- Chien Liu
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yi-Jung Li
- Kidney Research Center and Department of Nephrology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan; Department of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Hsin-Hsu Wu
- Kidney Research Center and Department of Nephrology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan; Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan, Taiwan
| | - Hsien-Ming Wu
- Department of Gynecology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Ya-Chung Tian
- Kidney Research Center and Department of Nephrology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan; Department of Medicine, Chang Gung University, Taoyuan, Taiwan.
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McCormick CA, de Crespigny PC, Suh N, Unterscheider J. Renal transplant injury at caesarean delivery: A cautionary tale and a plan for the future. Aust N Z J Obstet Gynaecol 2022; 62:332-335. [PMID: 35040486 DOI: 10.1111/ajo.13479] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 12/18/2021] [Accepted: 12/27/2021] [Indexed: 11/26/2022]
Abstract
Pregnancy following renal transplantation is increasingly common. Overall pregnancy outcomes are favourable; however, specific transplant-related risks do exist. In particular, the risk of caesarean delivery is much higher in renal transplant recipients when compared to the general obstetric population. This is owing to the necessity for preterm delivery in cases of severe and early-onset pre-eclampsia and/or fetal growth restriction. We describe two recent cases of renal transplant injury at caesarean delivery at our institution, a tertiary/quaternary obstetric service, which highlight the potential operative risks associated with abdominal surgery. We propose a standardised approach in the care of transplant recipients undergoing caesarean delivery which is aimed at minimising harm and increasing patient safety.
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Affiliation(s)
- Ciara Anne McCormick
- Department of Maternal Fetal Medicine, Royal Women's Hospital, Melbourne, VIC, Australia
| | | | - Nancy Suh
- Department of Transplant Surgery, The Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Julia Unterscheider
- Department of Maternal Fetal Medicine, Royal Women's Hospital, Melbourne, VIC, Australia.,Department of Obstetrics and Gynaecology, The University of Melbourne, Melbourne, VIC, Australia
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Laguna-Castro M, Rodríguez-Durán A, Cobacho-Salmoral O, Crespo-Montero R. Embarazo y trasplante renal. Una revisión sistemática. ENFERMERÍA NEFROLÓGICA 2021. [DOI: 10.37551/s2254-28842021029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Introducción: El trasplante renal es la mejor opción como tratamiento renal sustitutivo, por sus múltiples beneficios, permitiendo además a las mujeres con enfermedad renal crónica la posibilidad de embarazo y de una gestación exitosa.Objetivo: Conocer y sintetizar la producción científica más actualizada sobre el embarazo en mujeres con trasplante renal.Metodología: Se realizó una revisión sistemática siguiendo las recomendaciones de la declaración PRISMA, en las bases de datos PubMed, ProQuest, Scielo y Scopus. La estrategia de búsqueda se estableció con los siguientes descriptores: “pregnancy” y “kidney transplantation”. Se incluyeron artículos originales y revisiones sistemáticas, en español e inglés publicados entre 2015 y 2020.Resultados: Se seleccionaron 18 artículos. Se encontró una edad media de las mujeres trasplantadas en el momento del parto entre los 30 y 34 años y un tiempo medio entre el trasplante renal y el embarazo de 4,2 años. Las complicaciones más frecuentes en la madre fueron la preeclampsia, la hipertensión arterial inducida por el embarazo y la infección del tracto urinario, así como un aumento de la creatinina sérica y proteinuria. La mayoría de los embarazos terminaron en cesáreas y, entre los nacidos vivos, existió un gran número de prematuros.Conclusiones: El embarazo en mujeres con trasplante renal resulta exitoso siempre que la función renal se mantenga estable y no aparezcan complicaciones. Las complicaciones más frecuentes durante el embarazo son la hipertensión y la preeclampsia. La complicación más frecuente en el neonato es la prematuridad.
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Affiliation(s)
- Marta Laguna-Castro
- Departamento de Enfermería. Facultad de Medicina y Enfermería. Universidad de Córdoba. España
| | - Ana Rodríguez-Durán
- Departamento de Enfermería. Facultad de Medicina y Enfermería. Universidad de Córdoba. España
| | - Olga Cobacho-Salmoral
- Departamento de Enfermería. Facultad de Medicina y Enfermería. Universidad de Córdoba. España
| | - Rodolfo Crespo-Montero
- Departamento de Enfermería. Facultad de Medicina y Enfermería. Universidad de Córdoba. España. Servicio de Nefrología. Hospital Universitario Reina Sofía de Córdoba. España. Instituto Maimónides de Investigación Biomédica de Córdoba. España
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Yuksel Y, Yuksel D, Yucetin L, Erbis H, Sarier M, Karatas O, Emek M, Erdogan M, Yavuz A, Demirbas A. Use of Tacrolimus During Pregnancy After Kidney Transplantaion. Transplant Proc 2019; 51:2361-2366. [DOI: 10.1016/j.transproceed.2019.01.150] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 01/31/2019] [Indexed: 11/24/2022]
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Hortu I, Arı SA, Akdemir A, Koroglu OA, Yılmaz M, Toz H, Sagol S, Ergenoglu AM. Perinatal outcomes of renal transplant pregnancies: a 22-year experience at a single tertiary referral center. J Matern Fetal Neonatal Med 2019; 33:3028-3034. [PMID: 31288677 DOI: 10.1080/14767058.2019.1639664] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Background: Renal transplantation not only prolongs survival but also improves quality of life and fertility, particularly in patients with end-stage renal disease. The aim of this study was to evaluate the renal and perinatal outcomes of pregnancy after renal transplantation at a high volume academic tertiary hospital.Methods: Fifty-one renal transplant patients (RTPs) who experienced pregnancy after transplantation and received care at Ege University Hospital between January 1995 and December 2017 were retrospectively identified. Data on demographics, comorbidities, and clinical perinatal outcomes were analyzed.Results: The median age of expectant mothers with renal transplantation was 30.51 ± 5.28 years (range 23-41). The mean interval between discontinuing birth control methods and the last menstrual period was 22 months. Preeclampsia occurred in six pregnancies (11.5%), and 43 of 52 pregnancies resulted in live births (82.6%). The mean gestational age at birth was 36.35 ± 2.36 weeks (range: 26-38). A total of 15 births were preterm deliveries (28.8%). Intrauterine growth retardation (IUGR) was detected in four cases. The mean birth weight was 2664.58 ± 613.99 g (range: 600-3.800 g). Twelve newborns were hospitalized in the neonatal intensive care unit (23%). A significant inverse correlation between birth weight and preconception serum creatinine level was found (p < .001; r = -0.532). An inverse correlation between the interval between transplantation and pregnancy and low postpartum serum creatinine level was established significantly (p < .05; r = -0.331). In addition, an inverse correlation between preconceptional serum creatinine and postpartum serum creatinine in the first year was found statistically significant (p < .001, r = -0.681).Conclusion: Even though pregnancy does not seem to adversely affect renal graft function, risks of perinatal as well as obstetrical complications should not be ignored. Pregnancies in RTPs should be followed closely by a multidisciplinary team of experts to minimize perinatal complications before and during pregnancy.
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Affiliation(s)
- Ismet Hortu
- Department of Obstetrics and Gynecology, Ege University School of Medicine, Izmir, Turkey
| | - Sabahattin Anıl Arı
- Department of Obstetrics and Gynecology, Ege University School of Medicine, Izmir, Turkey
| | - Ali Akdemir
- Department of Obstetrics and Gynecology, Ege University School of Medicine, Izmir, Turkey
| | - Ozge Altun Koroglu
- Department of Pediatrics, Division of Neonatology, Ege University School of Medicine, Izmir, Turkey
| | - Mumtaz Yılmaz
- Department of Internal Medicine, Division of Nephrology, Ege University School of Medicine, Izmir, Turkey
| | - Huseyin Toz
- Department of Internal Medicine, Division of Nephrology, Ege University School of Medicine, Izmir, Turkey
| | - Sermet Sagol
- Department of Obstetrics and Gynecology, Ege University School of Medicine, Izmir, Turkey
| | - A Mete Ergenoglu
- Department of Obstetrics and Gynecology, Ege University School of Medicine, Izmir, Turkey
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Lee YS, Peng MY, Ker CR, Chan TF. Management of pregnancy in pancreas alone transplant recipient complicated with stage-4 chronic renal insufficiency and superimposed pre-eclampsia: Case report and literature review. Taiwan J Obstet Gynecol 2018; 56:700-702. [PMID: 29037563 DOI: 10.1016/j.tjog.2017.08.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2017] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVE With the prolonged life expectancy in solid organ transplant recipients, their quality of life and fertility desire become of particular concern. Pregnancy in pancreas-alone transplantation, although rare and complicated to manage, is not impossible anymore. We here report such a case with literature review to address this issue. CASE REPORT A 29-year-old, primigravida patient with underlying stage 4 chronic renal insufficiency and type 1 diabetes mellitus post pancreas-alone transplantation 5 years prior to her initial visit consulted our service. Antepartum care with intensive monitoring of blood pressure, renal function, and tacrolimus serum concentration were given. Successful maternal and fetal outcomes are presented here. CONCLUSION Child-bearing in solid organ transplantation recipients has become more promising nowadays, even for a difficult case of pancreas-alone transplant recipient complicated with chronic renal insufficiency and superimposed pre-eclampsia. Thorough antepartum counseling and cautious monitoring of maternal, fetal and graft conditions by multidisciplinary specialties are key to favorable pregnancy outcomes.
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Affiliation(s)
- Yung-Shih Lee
- Department of Obstetrics and Gynecology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan
| | - Mei-Yu Peng
- Department of Obstetrics and Gynecology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan
| | - Chin-Ru Ker
- Department of Obstetrics and Gynecology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Te-Fu Chan
- Department of Obstetrics and Gynecology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
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Hassan SM, Fahmy R, Omran EF, Hussein EA, Ramadan W, Abdelazim DF. Outcome of pregnancy after renal transplantation. Int J Womens Health 2018; 10:65-68. [PMID: 29416379 PMCID: PMC5790102 DOI: 10.2147/ijwh.s148386] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
AIM The aim of our study was to compare the outcome of pregnancy in patients who became pregnant within 24 months of renal transplantation and patients who became pregnant more than 24 months after renal transplantation. MATERIALS AND METHODS The sample population of our prospective cohort study comprised of 44 patients who became pregnant following renal transplantation. In all cases, living donors were used for renal transplantation. The patients were allocated into either group A, which included 24 patients who became pregnant more than 24 months after renal transplantation, or group B, which included 20 patients who inadvertently became pregnant within 24 months of renal transplantation. Serum creatinine and 24-hour urinary protein concentration were measured each trimester. The incidences of preeclampsia and gestational diabetes, the timing and mode of delivery, the rate of preterm labor, and the mean fetal birth weight were determined. RESULTS The mean gestational ages in groups A and B were 35.8±3 weeks and 34.1±2.5 weeks, respectively. The mean fetal birth weights in groups A and B were 2,480±316 g and 2,284.5±262 g, respectively. These differences were statistically significant. The incidence of preterm labor was 45.8% in group A and 55% in group B. Proteinuria was significantly higher in group B during the third trimester of pregnancy. Preeclampsia occurred in 25% of the cases in group A and 30% of the cases in group B; this difference was not statistically significant. Gestational diabetes occurred in 2 out of 24 cases in group A and 2 out of 20 cases in group B. For group A and group B, normal vaginal delivery occurred in 58.3% and 55% of cases, respectively, and cesarean section was performed in 41.6% and 45% of cases, respectively. CONCLUSION A longer interval between renal transplantation and pregnancy is associated with better pregnancy outcome.
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Affiliation(s)
| | - Radwa Fahmy
- Obstetrics and Gynecology Department, Cairo University, Cairo, Egypt
| | - Eman Fawzy Omran
- Obstetrics and Gynecology Department, Cairo University, Cairo, Egypt
| | - Eman Aly Hussein
- Obstetrics and Gynecology Department, Cairo University, Cairo, Egypt
| | - Wafaa Ramadan
- Obstetrics and Gynecology Department, Cairo University, Cairo, Egypt
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Yuksel Y, Tekin S, Yuksel D, Duman I, Sarier M, Yucetin L, Turan E, Celep H, Ugurlu T, Inal MM, Asuman YH, Demirbas A. Pregnancy and Delivery in the Sequel of Kidney Transplantation: Single-Center Study of 8 Years' Experience. Transplant Proc 2017; 49:546-550. [PMID: 28340831 DOI: 10.1016/j.transproceed.2017.02.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Depending on hyphothalamic, hyphophyseal, and gonadal axis dysfunction, anovulatory irregular cycles occur and the probability of pregnancy decreases in the patients with chronic kidney disease (CKD). Maternal mortality and morbidity rates are increased in CKD patients; the risk of premature delivery is 70% and the risk of preeclampsia is 40% more than normal among those with a creatine level of >2.5 mg/dL. METHODS If a pregnancy is expected in the sequel of kidney transplantation (KT), a multidisciplinary team approach should be adopted and both the gynecologist and the nephrologist should follow the patient simultaneously. Among 3883 patients who underwent KT at Antalya Medical Park Hospital Transplantion Department between November 2009 and October 2016, the records of 550 female patients between the ages of 18 and 40 years were examined retrospectively; 31 patients who complied with these criteria were included in the study group. In 6 of these patients who had an unplanned pregnancy, medical abortion was performed after the families were informed about the possible fetal anomalies caused by the use of everolimus in the first trimester, and they were excluded from the study (pregnant group). The control group consisted of 43 patients who had a KT and became pregnant, and of those who had recently undergone KT and shared similarities regarding age, CKD etiology, duration of dialysis, and number of transplants. RESULTS In both groups, the ages of the patients, their follow-up span and dialysis duration, tissue compatibility, age of the donor, and time elapsed until the pregnancy was analyzed, whereas in the control group, creatinine levels in the first, second, third, and fourth years after the KT were reviewed. Additionally, in the pregnant group, creatinine levels of the first, second, and third trimesters; delivery week; birth weight of the baby; APGAR scores of the first minute; postnatal creatinine levels of first, second, and third years; and prenatal, maternal, and postnatal acute rejections were reviewed. We measured the creatine clearance by use of the Cockcroft-Gault formula in the pregnancy group before pregnancy and during delivery [Cockcroft-Gault formula: (140 - age) × body weight (kg)/72 × plasma creatine level (mg/dL) × 0.85]. CONCLUSIONS Pregnancy after KT is risky both for the mother and the baby; however, if planned and followed in coordination within an experienced center, both the pregnancy period and the birth process can occur without distress.
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Affiliation(s)
- Y Yuksel
- Department of General Surgery and Transplantation, Medical Park Hospital, Antalya, Turkey.
| | - S Tekin
- Department of General Surgery, Faculty of Medicine, Kemerburgaz University, Istanbul, Turkey
| | - D Yuksel
- Department of Anesthesia, and Reanimasyon Unit, Training and Research Hospital, Antalya, Turkey
| | - I Duman
- Department of Urology, Faculty of Medicine, Kemerburgaz University, Istanbul, Turkey
| | - M Sarier
- Department of Urology, Faculty of Medicine, Kemerburgaz University, Istanbul, Turkey
| | - L Yucetin
- Department of General Surgery and Transplantation, Medical Park Hospital, Antalya, Turkey
| | - E Turan
- Department of General Surgery and Transplantation, Medical Park Hospital, Antalya, Turkey
| | - H Celep
- Department of General Surgery and Transplantation, Medical Park Hospital, Antalya, Turkey
| | - T Ugurlu
- Department of Obstetrics and Gynecology, Medical Park Hospital, Antalya, Turkey
| | - M M Inal
- Department of Obstetrics and Gynecology, Faculty of Medicine, Kemerburgaz University, Istanbul, Turkey
| | - Y H Asuman
- Department of Nephrology and Transplantation, Medical Park Hospital, Antalya, Turkey
| | - A Demirbas
- Department of General Surgery and Transplantation, Medical Park Hospital, Antalya, Turkey
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