 A substantial number of kidney transplant recipients and living kidney donors are women in their reproductive years. Does having an organ transplant or donating a kidney prevent them from becoming pregnant or carrying a pregnancy to full-term? According to experts in the field,
definitely not. The National Transplant Pregnancy Registry at Thomas Jefferson University in Philadelphia, reports that more than 1,000 infants have been born to kidney transplant recipients in the United States since the registry began tracking post-transplant births in the late 1970s.
“With the proper planning and advanced medical care, pregnancy for kidney transplant recipients can be very smooth,” says Leon Smith, Jr., M.D., Director of the Division of Maternal Fetal High-Risk Medicine at Saint Barnabas Medical Center. Dr. Smith and the team of high-risk obstetricians at Saint Barnabas have cared for more than 20 women whose pregnancy followed transplantation. “Their outcomes approach that of normal, low-risk mothers,” he says. “In fact, vaginal delivery is often possible.” Still, pregnancy after transplantation does require specialized care. Dr. Smith stresses that an expectant mother’s health care team should include her nephrologist, obstetrician and a high-risk obstetrician. “One kidney is enough to support both mother and fetus, but close monitoring of the mother, the fetus, the function of the transplanted kidney, and her overall health is essential for preventing serious complications.”
According to Dr. Smith, there are several important factors that a woman should consider before she plans a pregnancy.
- Foremost, he recommends she wait two years after the transplant before becoming pregnant. If an episode of organ rejection is going to occur, it is likely to happen within the first two years. Rejection is harder to reverse if the patient is pregnant because the treatment options are reduced.
- She should be in good overall health and have excellent control of any underlying disease such as diabetes, hypertension or lupus.
- It is also important that the mom-to-be undergo laboratory and ultrasound tests to ensure good kidney function before the stress of pregnancy.
For reasons that are still unknown, expectant mothers who have a transplanted organ have a higher incidence of the syndrome known as preeclampsia. The symptoms of preeclampsia are high blood pressure, protein in the urine and swelling of the face and hands. Mild preeclampsia is treated with bed rest and close monitoring of both the mother and baby. More severe cases may require an early delivery to eliminate any dangerous symptoms. The high-risk obstetrician will closely monitor the growth and development of the fetus to detect growth restriction that is also more common in post-transplant patients. “
Good post-transplant care and advanced immunosuppressive medications have resulted in a very healthy post-transplant state for women,” explains Dr. Smith. “A mother who coordinates her prenatal care with a multidisciplinary team of physicians has a wonderful opportunity for a sound pregnancy and a healthy baby.”
For women who have donated a kidney, the outlook is just as bright. Because living kidney donation is a relatively new practice, there is little scientific data involving kidney donation and pregnancy. However, Dr. Smith stresses that, “When one kidney is lost — whether it is donated or lost due to disease or injury — the remaining kidney is capable of performing up to 95 percent of the body’s entire kidney function. With this fact in mind, it is safe to say that female kidney donors do not give up their opportunity to bear children when they make the decision to donate a kidney.
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