University of Toledo, USA
Title: Pregnancy in women with renal transplant
Dinkar Kaw has completed his M.D. from Government Medical College, University of Kashmir, India. He completed his Residency in Internal Medicine and Fellowship in Nephrology from the Medical College of Ohio, Toledo, Ohio. He currently is an Associate Professor of Medicine at the University of Toledo, Ohio, USA. His special interests are in kidney disease and hypertension in pregnancy and kidney transplant medicine.
Pregnancy is uncommon in women with end stage renal disease because of impaired fertility. Renal transplant restores fertility & successful pregnancies have been reported in women with renal transplant. Pregnancy usually has no adverse effect on renal graft function and survival in women with normal renal graft function. However, pregnancy should be considered high risk in patients with renal transplant due to higher than normal incidence of hypertension & Pre-eclampsia. Th e outcome is not so favorable in patients who have some renal graft dysfunction at the time of conception which is comparable to outcome in chronic kidney disease patient with similar renal function. In addition, fetal outcome is not favorable with higher than normal incidence of intrauterine growth restriction and prematurity. Predictors of successful pregnancy outcome in renal transplant recipient are good general health for about 2 years after transplantation, good stable renal allograft function, and no recent episode of acute rejection, no evidence of ongoing rejection, normal blood pressure or minimal anti-hypertensive regimen, absence of or minimal proteinuria and absence of pelvi-calyceal dilatation on allograft ultrasound. Regarding the use of immunosuppressive medications during pregnancy, low dose prednisone & Cyclosporine or Tacrolimus at therapeutic levels are considered safer. Mycophenolate mofetil and Sirolimus are contraindicated and should be stopped 6 weeks before conception is attempted. Transplanted women in reproductive age group should be counseled about possible teratogenic eff ects of these medications & use of contraception while on these medications.