Kidney transplantation Archives - Revista Brasileira de Ginecologia e Obstetrícia
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2019;41(7):419-424
To assess maternal and perinatal outcomes in pregnancies after kidney transplantation in a tertiary center in Brazil.
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, andmaternal and perinatal outcomes were described as means and frequencies. Renal function and blood pressure were evaluated during pregnancy and postpartum.
A total of 22 women had at least 1 pregnancy during the considered timeinterval, 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 ± 46.3months. Themost frequent complication during pregnancywas hypertension, which affected 11 (64.7%)women. The gestational age at delivery was 34.7 ± 4weeks, 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.
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.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2019;41(7):419-424
To assess maternal and perinatal outcomes in pregnancies after kidney transplantation in a tertiary center in Brazil.
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, andmaternal and perinatal outcomes were described as means and frequencies. Renal function and blood pressure were evaluated during pregnancy and postpartum.
A total of 22 women had at least 1 pregnancy during the considered timeinterval, 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 ± 46.3months. Themost frequent complication during pregnancywas hypertension, which affected 11 (64.7%)women. The gestational age at delivery was 34.7 ± 4weeks, 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.
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.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2007;29(7):366-369
DOI 10.1590/S0100-72032007000700007
Fibroadenoma is the most frequent benign neoplasia in the female breast and it is considered a mixed tumor, constituted by variable amounts of connective and epithelial tissue. Cyclosporine A seems to be related with the development of mamary fibroadenomas in patients who underwent kidney transplantation in reproductive age. We reported the case in which the patient, in therapeutic use of cyclosporine A, after kidney transplantation, presented several bilateral lumps. The imaging and palpable findings suggested fibroadenoma, confirmed after biopsy.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2007;29(7):366-369
DOI 10.1590/S0100-72032007000700007
Fibroadenoma is the most frequent benign neoplasia in the female breast and it is considered a mixed tumor, constituted by variable amounts of connective and epithelial tissue. Cyclosporine A seems to be related with the development of mamary fibroadenomas in patients who underwent kidney transplantation in reproductive age. We reported the case in which the patient, in therapeutic use of cyclosporine A, after kidney transplantation, presented several bilateral lumps. The imaging and palpable findings suggested fibroadenoma, confirmed after biopsy.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2005;27(6):316-322
DOI 10.1590/S0100-72032005000600005
PURPOSE: to evaluate the relationship between renal transplantation and pregnancy through the analysis of clinical and obstetric intercurrent events and perinatal outcomes. METHODS: a retrospective series of 39 cases of pregnancy in 37 women with renal transplantation from January 1997 to December 2003 was evaluated. A control group consisted of 66 pregnant women with no previous clinical pathologies. This group received prenatal care and these patients delivered during 2002 and 2003. Preeclampsia, premature rupture of membranes, premature delivery, and intrauterine growth restriction were used to compare these variables. Demographic characteristics of these groups were related to the mean age at conception, ethnic characteristics and obstetric past. Regarding renal transplantation the type of donator and used immunosuppressive drugs were evaluated. The studied clinical variables were chronic hypertension, anemia and urinary tract infection. The interval between the surgery and conception, occurrence of dysfunction, rejection and loss of the allograft were characteristcs related to the allograft. Obstetric variables were related to the type of delivery, incidence of preeclampsia and premature rupture of membranes. Perinatal outcomes were premature delivery and intrauterine growth restriction and these results were compared with renal function. The used statistical methods were the chi2 and Fisher's exact tests. The significance level was fixed always as less than or equal to 0.05 (5%). RESULTS: the mean age at conception was 27 years. The live donator was the most frequent among the patients. Among the immunosuppressive drugs, cyclosporine was the most used. Chronic hypertension occurred in 82% of the cases, anemia in 77% and urinary tract infection in 38.5%. The incidence of renal dysfunction was 47.4% and preeclampsia was the main cause. The loss of the renal transplantation occurred in 10.2%. Delivery by cesarean section was performed in 53.8% of the patients, and the main causes were hypertensive syndromes. Preeclampsia occurred in 28.2%. Among the perinatal outcomes, premature delivery occurred in 46.1% of the cases, with a significant relation to creatinine level greater than or equal to 1.5 mg/dL at the start of prenatal care. Another observed intercurrent event was intrauterine growth restriction, which occurred in 41.0%, and here we found no relation between this event and creatinine levels. CONCLUSIONS: young patients constituted the study group. Chronic hypertension, anemia and urinary tract infection were very common. Renal dysfunction was frequent and must be investigated during prenatal care. There were four cases of loss of the transplant due to clinical or obstetric causes. Cesarean delivery had the highest incidence, but vaginal delivery should be the first choice in these cases. Preeclampsia occurred very frequently and this complication should be considered as a high risk. Preterm delivery and intrauterine growth restriction were the main perinatal complications. Premature deliveries before 37 weeks of gestation were related to allograft function.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2005;27(6):316-322
DOI 10.1590/S0100-72032005000600005
PURPOSE: to evaluate the relationship between renal transplantation and pregnancy through the analysis of clinical and obstetric intercurrent events and perinatal outcomes. METHODS: a retrospective series of 39 cases of pregnancy in 37 women with renal transplantation from January 1997 to December 2003 was evaluated. A control group consisted of 66 pregnant women with no previous clinical pathologies. This group received prenatal care and these patients delivered during 2002 and 2003. Preeclampsia, premature rupture of membranes, premature delivery, and intrauterine growth restriction were used to compare these variables. Demographic characteristics of these groups were related to the mean age at conception, ethnic characteristics and obstetric past. Regarding renal transplantation the type of donator and used immunosuppressive drugs were evaluated. The studied clinical variables were chronic hypertension, anemia and urinary tract infection. The interval between the surgery and conception, occurrence of dysfunction, rejection and loss of the allograft were characteristcs related to the allograft. Obstetric variables were related to the type of delivery, incidence of preeclampsia and premature rupture of membranes. Perinatal outcomes were premature delivery and intrauterine growth restriction and these results were compared with renal function. The used statistical methods were the chi2 and Fisher's exact tests. The significance level was fixed always as less than or equal to 0.05 (5%). RESULTS: the mean age at conception was 27 years. The live donator was the most frequent among the patients. Among the immunosuppressive drugs, cyclosporine was the most used. Chronic hypertension occurred in 82% of the cases, anemia in 77% and urinary tract infection in 38.5%. The incidence of renal dysfunction was 47.4% and preeclampsia was the main cause. The loss of the renal transplantation occurred in 10.2%. Delivery by cesarean section was performed in 53.8% of the patients, and the main causes were hypertensive syndromes. Preeclampsia occurred in 28.2%. Among the perinatal outcomes, premature delivery occurred in 46.1% of the cases, with a significant relation to creatinine level greater than or equal to 1.5 mg/dL at the start of prenatal care. Another observed intercurrent event was intrauterine growth restriction, which occurred in 41.0%, and here we found no relation between this event and creatinine levels. CONCLUSIONS: young patients constituted the study group. Chronic hypertension, anemia and urinary tract infection were very common. Renal dysfunction was frequent and must be investigated during prenatal care. There were four cases of loss of the transplant due to clinical or obstetric causes. Cesarean delivery had the highest incidence, but vaginal delivery should be the first choice in these cases. Preeclampsia occurred very frequently and this complication should be considered as a high risk. Preterm delivery and intrauterine growth restriction were the main perinatal complications. Premature deliveries before 37 weeks of gestation were related to allograft function.