Can a woman with a kidney transplant become pregnant?
Fertility is usually restored by kidney transplant. Three broad areas of concern are:
- • The effect of pregnancy on the kidney allograft.
- • The effect of immunosuppressive medication on the fetus.
- • The risk of opportunistic infection.
Women are advised to wait a year after transplant, and to only become pregnant if they have stable kidney function with a serum creatinine of less than 2 mg/dL. As in other kidney diseases, the most important risk factor for worsening kidney function is poor kidney function prior to pregnancy. Statins and angiotensin-converting enzyme (ACE) inhibitors must be stopped before conception. Mycophenolate mofetil is associated with increased congenital anomalies and should also be stopped prior to conception. About 50% of pregnancies in women taking mycophenolate end in spontaneous abortion and 30% of live born infants have congenital anomalies. Cyclosporine and tacrolimus are associated with small-for-gestational-age babies. Prednisone and azathioprine are widely used without major problems. There is no information on sirolimus, everolimus, and belatacept.
Infectious diseases such as cytomegalovirus (CMV), toxoplasmosis, herpes simplex, and listeria, which are seen in transplant recipients, pose a risk for the fetus. Transplant recipients are at increased risk for CMV during pregnancy. CMV is a leading cause of developmental delay and sensorineural hearing loss. Of women who are seronegative at conception, 1% to 4% will develop a primary infection during pregnancy. There are case reports of successful use of valganciclovir in women with CMV during pregnancy. The data are scant and more data are needed regarding both efficacy and safety. CMV hyperimmune globulin has also been used, but again, data are limited. Treatment with ganciclovir should be used if maternal disease requires treatment.
