移植後妊娠4症例の検討

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  • Pregnancies in renal transplant recipients: effects on kidney function

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【Objective】Pregnancy after renal transplantation sometimes severely affects function of a grafted kidney. The aim of this study is to reveal the influence of pregnancy on kidney grafts.<br/> 【Design】Retrospective study of 4 cases.<br/> 【Methods】From Apr. 2004 to Nov. 2014, a total 371 cases were followed for immunosuppressive therapy after renal transplantation. Among them, 4 cases experienced 5 pregnancies. The course of the 5 pregnancies was reviewed and the deterioration of the graft function analyzed.<br/> 【Results】Primary renal diseases were IgA nephropathy (n=3) and chronic glomerulonephritis (n=1). The maintenance immunosuppressive agents consisted of calcineurin inhibitor (cyclosporine A n=3; tacrolimus n=1), antimetabolite (mycophenolate mofetil was changed to azathioprine), and prednisolone. Pregnancies in 2 cases had no trouble in the graft kidneys. In another case, function of the graft kidney deteriorated after the delivery. The rate of increase in serum creatinine was 11%. The 4th case, which had a recurrence of IgA nephropathy, had a normal course in her first pregnancy and labor at term after transplantation, but she developed a complication of preeclampsia during the second pregnancy. This caused severe activation of the recurrent IgA nephropathy, which necessitated reintroduction to dialysis therapy within half a year.<br/> 【Conclusion】In cases with potential deleterious effects on kidney grafts, more detailed informed consent is required, as shown here, with the risk involved in pregnancy after renal transplantation, which, however is minimal if the graft condition is good. If a transplant patient is determined to have a child in spite of the risk of kidney dysfunction, more rigorous control is required of general conditions, especially of blood pressure.

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  • 移植

    移植 50 (6), 621-626, 2015

    一般社団法人 日本移植学会

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