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Q J Med 2003; 96: 837-844
© 2003 Association of Physicians

Pregnancy in renal transplant recipients: the Royal Free Hospital experience

B.C. Thompson1, E.J. Kingdon1, S.M. Tuck2, O.N. Fernando1 and P. Sweny1

From the 1Centre for Nephrology and 2Department of Obstetrics and Gynaecology, Royal Free and University College School of Medicine, London, UK

Received 17 March 2003 and in revised form 28 August 2003

Background: For women with end-stage renal failure of child-bearing age, renal transplantation offers a chance to start a family. Pregnancies in renal transplant recipients involve risks for graft and fetus, and need to be carefully managed.

Aim: To identify graft, fetal and maternal outcomes in our patients, and compare our results with those of the large national transplant registries.

Design: Retrospective case-note review.

Methods: We assessed the outcomes of 48 pregnancies in 24 renal transplant recipients. Obstetric data and renal parameters were examined in 27–30 pregnancies that progressed to delivery.

Results: Mean time from transplantation to pregnancy was 6.5 years, with an unfavourable outcome in patients who conceived within 1 year. There was a 41% incidence of fetal growth restriction (FGR), and 33% of infants were small for gestational age. FGR was associated with maternal hypertension, a pre-pregnancy serum creatinine (SCr) >= 133 µmol/l (1.5 mg/dl), calcineurin inhibitors and the use of cardioselective ß blockers. Two patients with pre-pregnancy SCr > 200 µmol/l lost their grafts within 3 years of delivery. A permanent significant decline in graft function occurred in 20%, by 6 months post delivery.

Discussion: FGR with SGA infants occurs frequently. Atenolol should be avoided in pregnancy and Metoprolol should not be combined with calcineurin inhibitors. Pregnancy appeared to have a deleterious effect on graft function in patients with SCr > 155 µmol (1.75 mg/dl). Patients with pre-pregnancy SCr 200 µmol/l are at greatest risk.

Address correspondence to Dr B.C. Thompson, Centre for Nephrology, Royal Free Hospital, Pond Street, London NW3 2QG. e-mail: sbjbi{at}hotmail.com


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