Pregnancy and Kidney Transplantation, Triple Hazard? Current Concepts and Algorithm for Approach of Preconception and Perinatal Care of the Patient With Kidney Transplantation

IntroductionKidney transplantation (KT) increases fertility in patients with chronic kidney disease (CKD); their pregnancies are considered of high risk because of higher incidence of complications. The objective of this study was to propose, based on current concepts, an algorithm for preconception and perinatal care of KT recipients with a desire for parity.Materials and MethodsWe searched for literature published within the last 10 years related to pregnancy and KT. Based on the results, we developed an algorithm for the approach to preconception/perinatal care of these patients.ResultsPreconception care begins with pre-KT study of women of childbearing age, continues with contraception, and ends with the proper selection of candidates; an exhaustive study of health condition, function of renal graft, and infections that may affect the fetus is required; fetotoxic drugs must be suspended, immunosuppression must be based in corticosteroids, azathioprine, and tacrolimus or cyclosporine. Once conception is achieved, prenatal care should be done by a multidisciplinary team; follow-up of graft function and maternal-fetal health must be strict. Pregnancy has no deleterious effect on graft function; pelvic localization of graft does not contraindicate vaginal delivery; breastfeeding is indicated if immunosuppressive levels in the newborn are low.ConclusionsKT returns the possibility of motherhood to women with CKD. Proper selection and optimal care of patients determines success in maternal, fetal, and graft results.