Renal graft and pregnancy (Literature review)

The article is devoted to a review of the literature, which highlights the issues of maternal and perinatal complications and management of pregnant women who are renal transplant recipients.The risks of the development of hypertensive complications, preeclampsia, infectious complications, gestational diabetes and the risk of the fetus during pregnancy in these women are discussed in details. Pregnancy does not cause graft rejection, but pregestational hypertension, increased plasma creatinine and significant pregestational proteinuria are the risk factors for this complication. Pregnant women with a kidney transplant have a significantly higher risk of fetal growth retardation and premature birth.The article provides recommendations for the optimal period for pregnancy after transplantation which are recommended by various professional medical societies, although there is still no agreement on this issue: the American Society of Transplantation claims that the ideal period is 12-24 months after transplantation, while European best practice guidelines recommends to plan pregnancy no earlier than 2 years after surgery.The observation of pregnant women who are renal transplant recipients should be performed by an obstetrician-gynecologist with experience in high-risk pregnancy together with a transplantologist and perinatologist or neonatologist. All pregnant women who are kidney transplant recipients should be monitored for blood pressure, and aggressive antihypertensive therapy should be prescribed if it increases. It is also necessary to monitor the function of the graft, on suspicion of rejection it is possible to perform ultrasound-controlled kidney biopsy.The principles of immunosuppressive therapy during pregnancy, which includes prednisolone, methylprednisolone, tacrolimus, cyclosporine and azathioprine, and the description the side effects for the mother, the impact on the fetus and breastfeeding of each of the drugs are presented in the article. In the absence of obstetric complications, the optimal method of delivery is spontaneous delivery through the natural birth canal in the term of 38-40 weeks of pregnancy. Breastfeeding is recommended despite immunosuppressive therapy. Breast-feeding should be avoided when such medications as mycophenolate mofetil, sirolimus, everolimus and belatacept are used.Despite the high risk of pregnancy and childbirth, kidney transplant recipients have a good chance of pregnancy outcomes and giving birth to a living child while maintaining their own health. Therefore, motherhood should be encouraged among such women, supported and provided with highly qualified medical care.