Pregnancy in renal transplantation: Recipient and donor aspects in the Arab world

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• 作者：Aleksandra Kukla ; Naim Issa ; Hassan N. Ibrahim ; ^{ibrah007@umn.edu} ; ^{erick377@umn.edu}
• 关键词：ESKD ; end-stage kidney disease ; KDIGO ; kidney disease ; improving global outcomes ; CMV ; cytomegalovirus
• 刊名：Arab Journal of Urology
• 出版年：2012
• 期刊代码：pca60_2090598X
• 类别：med
• 出版时间：June, 2012
• 卷：10
• 期：2
• 页码：175-181
• 文件大小：378 K

摘要

Objective

There are many kidney transplant recipients and living donors of reproductive age, and the prevalence of pregnancies in kidney transplant recipients can reach 55%in the Middle Eastern countries. Living kidney donation is predominant in this region. As the risks and outcomes of pregnancy should be a part of counselling for both recipients and donors, we reviewed available reports on maternal and foetal outcomes in these particular populations.

Methods

Information was obtained from retrospective analyses of a large database, and from single-centre reports indexed in PubMed on pregnancy in donors and kidney transplant recipients. The keywords used for the search included 鈥榝ertility鈥? 鈥榢idney disease鈥? 鈥榩regnancy鈥? 鈥榤aternal/foetal outcomes鈥? 鈥榢idney transplant recipient鈥? 鈥榠mmunosuppression side-effects鈥? 鈥榣iving donor鈥?and 鈥楢rab countries鈥?

Results

Pregnancies in kidney transplant recipients are most successful in those with adequate kidney function and controlled comorbidities. Similarly to other regions, pregnant recipients in the Middle East had a higher risk of pre-eclampsia (26%) and gestational diabetes (7%) than in the general population. Caesarean section was quite common, with an incidence rate of 61%, and the incidence of pre-term birth reached 46%.

Conclusions

Most living donors can have successful pregnancies and should not be routinely discouraged. Women who had pregnancies before and after donation were more likely to have adverse maternal outcomes (gestational diabetes, hypertension, proteinuria, and pre-eclampsia) in the latter, but no adverse foetal outcomes were found after donation. The evaluation before donation should include a gestational history and counselling about the potential risks.