肾移植术后妊娠分娩双胞胎1例报告并文献复习

Successful pregnancies of twins in female renal transplant recipients:a case report and literature review

目的探讨肾移植受者妊娠分娩对子代、移植肾和自身健康的影响。方法回顾性分析1例肾移植受者妊娠分娩双胞胎的临床资料并复习相关文献。结果 1例肾移植受者于2009年7月在解放军第117医院接受同种异体肾移植术,术后应用他克莫司+咪唑立宾+泼尼松三联免疫抑制方案。术后约2年计划妊娠前咪唑立宾换为硫唑嘌呤。换药后1.5个月,产前检查为宫内孕双活胎。孕31+5周移植肾超声检查提示肾盂分离3.3cm,血清肌酐82μmol/L,24h尿蛋白定量800mg,血压正常。2d后行剖宫产,顺利娩取2名活男婴,体质量分别为1750g和1610g,5minApgar评分均为10分,均人工喂养。结论女性肾移植受者术后2年左右、肝肾功能稳定、全身状况良好,可以妊娠、分娩。期间强调合理的免疫抑制方案,新生儿建议人工喂养。妊娠和分娩并发症对移植肾和受者有一定影响。

Objective To investigate the effects of twin pregnancies after renal transplantation on the mother, renal allograft, and the condition of the fetus. Methods A 31-year-old woman gave birth to twins about 3 years after renal transplantation. Related literatures were reviewed. Results The woman received renal transplantation in July 2009 and maintained immunosuppressive treatment with tacrolimus, mozoribine, and prednisone. About 2 years after transplantation, mozoribine was converted to azathioprine before planning to pregnancy and the pregnancy of twins happened 1.5 month after conversion. Ultrasound at G31 ＋5 week showed a 3.3 cm distance between renal aUograft and the pelvis in the patient; serum creatinine was 82 μmol/L; 24 h proteinuria was 800 mg; and blood pressure was normal. Two days later, the woman successfully gave birth to the male twins with weights of 1750 g and 1610 g and 5 min Apgar scores were 10 and 10, respectively. The infants were fed with formula milk. Conclusion Our experience indicated that female renal recipients could have successful pregnancy about 2 years after transplantation when they are in good condition with stable liver and renal function. Reasonable immunusuppression strategy is the key issue during pregnancy and formula feeding may be more suitable for the infants after parturition. Complications of pregnancy and parturition have influence on the function of renal allograft to a certain degree.