Abstract: FR-PO1151
Pregnancy After Kidney Transplantation Complicated by Trisomy 21
Session Information
- Transplantation: Clinical - Transplant Access, Recipient Evaluation, Living Donors, Pregnancy, and More
October 23, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 2002 Transplantation: Clinical
Authors
- Javed, Numan, Geisinger Health, Danville, Pennsylvania, United States
- Coscia, Lisa, National Transplantation Pregnancy Registry (NTPR), Phildelphia, Pennsylvania, United States
- Sanghi, Pooja, Geisinger Health, Danville, Pennsylvania, United States
Introduction
Despite advances in transplantation and immunosuppression, pregnancy in renal transplant recipients is associated with increased maternal and fetal risks including hypertensive disorders, prematurity, and medication-related teratogenicity.
Case Description
A 39-year-old woman with ESRD secondary to polycystic kidney disease underwent a second deceased donor kidney transplant in 2019 after initial graft thrombosis.She received Thymoglobulin induction and was maintained on belatacept ,MMF, and prednisone daily.She had stable graft function with creatinine of 1mg/dl. She remained on lisinopril for proteinuria management.
Four years later, she reported an unintended pregnancy at approximately six weeks gestation while using Nuvaring for contraception. Lisinopril and MMF were discontinued, and Azathioprine was initiated. Fetal DNA screening and amniocentesis confirmed trisomy 21 with additional 7p22.3 and 7q35 deletions. After multidisciplinary counseling, she underwent dilation and evacuation at 17 weeks.
Discussion
Post transplant pregancy warrants preconception counselling and careful IS planning. Discontinuation of MMF should be done at least 6 weeks before pregancy and transition to Azathioprine should be done before attempting conception.Trisomy 21 is not recognised component of MMF embyropathy with no registry data linking MMF exposure to trisomy 21. Although mouse models have shown MMF genotoxicity, there are no reports of aneuploidy in human pregnancies.This case highlights importance of effective contraception while on MMF and karyotyping in those exposed during pregnancy. Advanced maternal age certainly was a related risk factor. Close coordination among transplant nephrology, maternal-fetal medicine, and genetics is prime.
Conclusion: Pregnancy in renal transplant recipients requires chosing safe IS regimen, close graft surveillance, and comprehensive genetic evaluation.This case highlights importance of proactive counselling post Tx to prevent late pregancy terminations.