Revista Brasileira de Ginecologia e Obstetrícia / RBGO Gynecology and Obstetrics, Inhaltsverzeichnis

CC BY 4.0 · Rev Bras Ginecol Obstet 2019; 41(07): 419-424
DOI: 10.1055/s-0039-1688834

Original Article

Thieme Revinter Publicações Ltda Rio de Janeiro, Brazil

Pregnancy Among Women with Kidney Transplantation: A 20-Years Single-Center Registry

Gravidez em transplantadas renais: registro de 20 anos de um centro de referência

Stephanye Mariano

¹Departament of Tocogynecology, School of Medical Sciences, Universidade Estadual de Campinas, SP, Brazil

,

Jose Paulo de Siqueira Guida

¹Departament of Tocogynecology, School of Medical Sciences, Universidade Estadual de Campinas, SP, Brazil

,

Marcos Vinicius de Sousa

²Renal Transplant Research Laboratory, Renal Transplant Unit, Division of Nephrology, School of Medical Sciences, Universidade Estadual de Campinas, SP, Campinas, Brazil

,

Mary Angela Parpinelli

¹Departament of Tocogynecology, School of Medical Sciences, Universidade Estadual de Campinas, SP, Brazil

,

Fernanda Garanhani Surita

¹Departament of Tocogynecology, School of Medical Sciences, Universidade Estadual de Campinas, SP, Brazil

,

Marilda Mazzali

²Renal Transplant Research Laboratory, Renal Transplant Unit, Division of Nephrology, School of Medical Sciences, Universidade Estadual de Campinas, SP, Campinas, Brazil

,

Maria Laura Costa

¹Departament of Tocogynecology, School of Medical Sciences, Universidade Estadual de Campinas, SP, Brazil

› Institutsangaben

Abstract

Objective To assess maternal and perinatal outcomes in pregnancies after kidney transplantation in a tertiary center in Brazil.

Methods Retrospective cohort of pregnancies in women with kidney transplantation at the Universidade Estadual de Campinas, from January 1995 until December 2017. Medical charts were reviewed, and maternal and perinatal outcomes were described as means and frequencies. Renal function and blood pressure were evaluated during pregnancy and postpartum.

Results A total of 22 women had at least 1 pregnancy during the considered time interval, and 3 of them had > 1 pregnancy, totalizing 25 pregnancies. The mean age at transplantation was of 24.6 ± 4.2 years old, and the mean time interval until pregnancy was of 67.8 ± 46.3 months. The most frequent complication during pregnancy was hypertension, which affected 11 (64.7%) women. The gestational age at delivery was 34.7 ± 4 weeks, and 47% of these pregnancies were preterm (< 37 weeks). A total of 88.2% of the women delivered by cesarean section. Renal function, measured by serum creatinine, remained stable during pregnancy, and the systolic blood pressure increased significantly, while the diastolic blood pressure did not differ during pregnancy.

Conclusion Pregnancy after kidney transplantation is a rare event. Pre-eclampsia and prematurity were frequent complications, and cesarean section rates were very high. A specialized antenatal and postpartum care with a multiprofessional approach and continuous monitoring of graft function are essential for the early diagnosis of complications and improved outcomes.

Resumo

Objetivo Avaliar os resultados maternos e perinatais de gestações em mulheres transplantadas renais em um centro terciário no Brasil.

Métodos Coorte retrospectiva de gestações entre mulheres transplantadas renais na Universidade Estadual de Campinas, de Janeiro de 1995 a Dezembro de 2017. Os prontuários médicos foram revisados, e os resultados maternos e perinatais foram descritos como médias e frequências. A função renal e a pressão arterial foram avaliadas durante a gravidez e o puerpério.

Resultados Um total de 22 mulheres tiveram ao menos 1 gravidez durante o período avaliado, e 3 delas tiveram > 1 gestação, totalizado 25 gestações. A idade média no momento do transplante foi 24.6 ± 4.2 anos, e o tempo médio de intervalo até a gravidez foi de 67.8 ± 46.3 meses. A complicação mais frequente durante a gravidez foi a hipertensão, que acometeu 11 (64.7%) mulheres. A idade gestacional no parto foi de 34.7 ± 4 semanas, e 47% das gestações encerraram-se prematuramente (< 37 semanas). Um total de 88.2% das gestações terminou com uma cesárea. A função renal, avaliada pela creatinina sérica, permaneceu estável durante a gravidez, enquanto a pressão arterial sistólica aumentou significativamente. A pressão arterial diastólica não diferiu ao longo dos períodos avaliados.

Conclusão Gestação após o transplante renal é um evento raro. Pré-eclâmpsia e prematuridade foram as complicações mais frequentes, e as taxas de cesárea foram muito altas. O cuidado multiprofissional no pré-natal e no puerpério e a constante monitoração da função do enxerto são fundamentais para diagnosticar precocemente complicações e melhorar os resultados.

Keywords

Keywords

kidney transplantation - pregnancy - high-risk - hypertension - premature birth - dialysis

Palavras-chave

Palavras-chave

transplante renal - gravidez de alto risco - hipertensão - parto prematuro - diálise

References
1 Sharaf El Din UA, Salem MM, Abdulazim DO. Stop chronic kidney disease progression: Time is approaching. World J Nephrol 2016; 5 (03) 258-273 . Doi: 10.5527/wjn.v5.i3.258
2 Sesso RC, Lopes AA, Thomé FS, Lugon JR, Martins CT. Brazilian chronic dialysis survey 2016. J Bras Nefrol 2017; 39 (03) 261-266 . Doi: 10.5935/0101-2800.20170049
3 Registro Brasileiro de Transplantes. 2018 ; 24(3). São Paulo, SP: Associação Brasileira de Transplante de Órgãos. http://www.abto.org.br/abtov03/Upload/file/RBT/2018/rbt2018-let-3t.pdf . Accessed 16 Jan, 2019.
4 Nadeau-Fredette AC, Hladunewich M, Hui D, Keunen J, Chan CT. End-stage renal disease and pregnancy. Adv Chronic Kidney Dis 2013; 20 (03) 246-252 . Doi: 10.1053/j.ackd.2013.01.010
5 Hou S. Pregnancy in renal transplant recipients. Adv Chronic Kidney Dis 2013; 20 (03) 253-259 . Doi: 10.1053/j.ackd.2013.01.011
6 Başaran O, Emiroğlu R, Seçme S, Moray G, Haberal M. Pregnancy and renal transplantation. Transplant Proc 2004; 36 (01) 122-124 . Doi: 10.1016/j.transproceed.2003.11.011
7 Rocha A, Cardoso A, Malheiro J. , et al. Pregnancy after kidney transplantation: graft, mother, and newborn complications. Transplant Proc 2013; 45 (03) 1088-1091 . Doi: 10.1016/j.transproceed.2013.02.006
8 Blume C, Pischke S, von Versen-Höynck F, Günter HH, Gross MM. Pregnancies in liver and kidney transplant recipients: a review of the current literature and recommendation. Best Pract Res Clin Obstet Gynaecol 2014; 28 (08) 1123-1136 . Doi: 10.1016/j.bpobgyn.2014.07.021
9 Shah S, Verma P. Overview of pregnancy in renal transplant patients. Int J Nephrol 2016; 2016: 4539342 . Doi: 10.1155/2016/4539342
10 von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. ; STROBE Initiative. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. PLoS Med 2007; 4 (10) e296 . Doi: 10.1371/journal.pmed.0040296
11 Colla L, Diena D, Rossetti M. , et al. Immunosuppression in pregnant women with renal disease: review of the latest evidence in the biologics era. J Nephrol 2018; 31 (03) 361-383 . Doi: 10.1007/s40620-018-0477-3
12 Erman Akar M, Ozekinci M, Sanhal C. , et al. A retrospective analysis of pregnancy outcomes after kidney transplantation in a single center. Gynecol Obstet Invest 2015; 79 (01) 13-18 . Doi: 10.1159/000365815
13 Perales-Puchalt A, Vila Vives JM, López Montes J, Diago Almela VJ, Perales A. Pregnancy outcomes after kidney transplantation-immunosuppressive therapy comparison. J Matern Fetal Neonatal Med 2012; 25 (08) 1363-1366 . Doi: 10.3109/14767058.2011.634461
14 Guerra Junior AA, Acúrcio FA, Andrade EI. , et al. Cad Saude Publica 2010; 26: 163-174 . Doi: 10.1590/S0102-311 × 2010000100017
15 Josephson MA, McKay DB. Women and transplantation: fertility, sexuality, pregnancy, contraception. Adv Chronic Kidney Dis 2013; 20 (05) 433-440 . Doi: 10.1053/j.ackd.2013.06.005
16 Filippi V, Chou D, Barreix M, Say L. ; the WHO Maternal Morbidity Working Group. A new conceptual framework for maternal morbidity. Int J Gynaecol Obstet 2018; 141: 4-9 . Doi: 10.1002/ijgo.12463
17 Candido C, Cristelli MP, Fernandes AR. , et al. Pregnancy after kidney transplantation: high rates of maternal complications. J Bras Nefrol 2016; 38 (04) 421-426 . Doi: 10.5935/0101-2800.20160067
18 Oliveira LG, Sass N, Sato JL, Ozaki KS, Medina Pestana JO. Pregnancy after renal transplantation--a five-yr single-center experience. Clin Transplant 2007; 21 (03) 301-304 . Doi: 10.1111/j.1399-0012.2006.00627.x
19 Madej A, Mazanowska N, Szpotańska-Sikorska M. , et al. Delivery method in patients after liver or kidney transplantation. Transplant Proc 2018; 50 (07) 2150-2153 . Doi: 10.1016/j.transproceed.2018.05.003
20 Juliato CRT, Stahlschmidt P, Fernandes A, Monteiro I, Bahamondes L. A case series on the use of levonorgestrel 52 mg intrauterine system after organ transplant. Contraception 2018; 98 (03) 252-254 . Doi: 10.1016/j.contraception.2018.04.017