Abstract: FR-PO852
Hey Baby, the Kidney Allograft Is Not a Pillow: A Complex Case of Pregnancy in a Kidney Transplant Recipient
Session Information
- Women's Health and Kidney Diseases
November 03, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Women's Health and Kidney Diseases
- 2200 Women's Health and Kidney Diseases
Authors
- Nguyen, Joseph D., University of Virginia School of Medicine, Charlottesville, Virginia, United States
- Rao, Swati, UVA Health, Charlottesville, Virginia, United States
Introduction
Pregnancy in kidney transplant recipients (KTR) have favorable patient, allograft, and fetal outcomes. However, these pregnancies are high-risk for pre-eclampsia (25%), preterm (50%), and C-section (50%). While rates of rejections are low (1-2%), there are high rates of urinary tract infection (UTI) and multifactorial acute kidney injury (40%). We report a case of pregnancy in KTR with a successful outcome despite multiple complications.
Case Description
A 35-year-old with ESKD due to sickle cell disease with kidney transplant 3 years ago had her first planned pregnancy. The first two trimesters were complicated by recurrent UTIs (rUTIs) managed with suppressive antibiotics. At 24 weeks, mild hydronephrosis of the allograft was seen on ultrasound, which progressed to moderate hydronephrosis by week 36 due to the fetal head compressing the renal hilum (Fig 1A/B). Pre-eclampsia developed at 28 weeks; initial hypertension was followed by proteinuria at 34 weeks. Delivery was performed by C-section due to fetal distress at 37 weeks. Meticulous surgical technique ensured the safety of the transplanted ureter. Two days after delivery, hydronephrosis was improved (Fig 1C). She did not have a sickle cell crisis during pregnancy, with the use of erythropoietin stimulating agents and 1 unit of blood transfusion during C-section.
Discussion
Fertility and sexual health are important quality-of-life metrics in KTR, and our patient was determined to pursue pregnancy. Her case is an example of multidisciplinary care by transplant nephrology, maternal-fetal medicine, hematology, and transplant surgery supporting a complex case of pregnancy in KTR. Prior to conception, her allograft function, immunosuppressive regimen, and comorbidities were optimized. Despite multiple insults to the allograft (rUTIs, pre-eclampsia, and hydronephrosis), creatinine remained stable (0.8mg/dL). Postpartum, blood pressure and hydronephrosis are rapidly improving. Proteinuria persists but we expect improvement in the next few weeks as VEGF signaling normalizes and endothelial-podocyte homeostasis recovers.
Ultrasound of transplanted kidney at 24 weeks (A), 36 weeks (B) with fetal head compressing renal hilum (white arrow), and 2 days postpartum (C).