Pregnancy outcome in renal transplant recipients: Indian scenario

Background: Pregnancy in renal transplant recipient is a high risk pregnancy, associated with increased risk of graft rejection and other complications. Many pregnancies have been reported, still there is limited data on optimal counseling and clinical management of these patients. Objectives: To study maternal and fetal outcomes in renal transplant recipients. Material and methods: Study design: This is a retrospective observational study conducted at tertiary health center in Ahmedabad, from 2004 to 2014. Sample size: There were 3016 renal transplant recipients out of which 2507 were males and 509 were females. Among 509 females, 211 recipients were in reproductive age group (20–40 years) who were included in the study. Out of 211 recipients, 113 (53.5%) had complete family, 46 (21.8%) did not tried for pregnancy, 33 (15.63%) were lost to follow up, 16 (7.58%) patients conceived and 3 (1.41%) were infertile. Method: Maternal and fetal outcomes were studied and patients were followed up till 2 years of postpartum. Exclusion criteria: Unmarried, divorcee and widow patients were excluded. Results: There were 16 patients who had conceived, out of which 8 patients had abortions, 6 patients had full term deliveries and 2 patients had preterm delivery. Two patients developed newly diagnosed gestational hypertension from 20 weeks of gestation. One patient had graft rejection 2 months post abortion and one had cholestasis of pregnancy from 7 months of gestation. On follow up, one patient expired 1 year after abortion due to tuberculosis meningitis and one patient (10 months post abortion) is on intermittent hemodialysis since 3 months, after 1.5 years of renal transplant. Conclusion: These patients are at risks for developing many complications during pregnancy, out of which graft rejection is most grievous one. However, with proper peritransplant and periconceptional counseling regarding optimal time for pregnancy, these patients can have good pregnancy outcome.