肾移植受者术后妊娠结局分析

Pregnancy Outcomes for Kidney Transplant Recipients

目的:探讨肾移植受者术后的妊娠结局。方法:回顾性分析2009年1月至2019年12月在四川大学华西第二医院建卡规律产检、孕周≥28周且住院分娩的12例肾移植受者临床资料,并随访其子代至出生后48个月。结果:12例患者分娩年龄29.6±2.2岁,妊娠距肾移植时间38.8±17.4月,分娩孕周36.0±1.7周,孕期免疫抑制剂方案均为泼尼松+他克莫司+硫唑嘌呤,其中8例孕前半年至6周停用吗替麦考酚酯,孕期无急慢性排斥反应。7例为肾性高血压,其中5例孕晚期并发子痫前期;早产9例;尿路感染1例;肾性贫血1例;腹壁切口感染1例;妊娠期糖尿病3例;胎膜早破5例。剖宫产11例,阴道分娩1例,其中3例因产科指征行剖宫产;1例因肾性贫血、移植肾积水、肾盂扩张行剖宫产。12例患者产后42天复查情况均良好,无排斥反应、无移植肾丢失。12例均为单胎、活产,低体质量儿3例;新生儿出生时均无出生缺陷及畸形,均为人工喂养。随访中子代年龄18.3±13.2月,生长发育、智力、学习能力和心理发育与同龄者均无差异。结论:肾移植受者术后妊娠虽然为高危妊娠,但在多学科团队协作管理和严密监护下,选择恰当时机妊娠,制定个体化的治疗方案,适时终止妊娠,可有效提高肾移植受者妊娠的安全性。

Objective:To explore the perinatal outcomes of pregnancy with kidney transplantation.Methods:We retrospectively analyzed the clinical data from January 2009 to December 2019 of 12 kidney transplant recipients who had regular prenatal examination,and hospitalized delivery after 28 gestational weeks.Their offspring were followed up to 48 months after birth.Results:Maternal age of 12 recipients was 29.6±2.2 years,the average interval between renal transplantation and pregnancy was 38.8±17.4 months,and the mean gestational weeks at delivery was 36.0±1.7 weeks.Among the 12 recipients,Prednisone+Tacrolimus+Azathioprine was used as the immunosuppressive regimen during pregnancy,and 8 of them switched from mycophenolate mofetil to Azathioprine from half a year to six weeks before attempting conception.And there was no acute or chronic rejection during pregnancy.There were 7 cases of renal hypertension during pregnancy,of which 5 cases developed preeclampsia in the third trimester,premature delivery in 9 cases,urinary tract infection in 1 case,renal anemia in 1 case,abdominal incision infection in 1 case,gestational diabetes mellitus in 3 cases,and premature rupture of membranes in 5 cases.Eleven recipients had cesarean section and only one recipient had vaginal delivery,of which 3 cases were cesarean section due to obstetric adaptations,1 case due to renal anemia,hydronephrosis and dilatation of renal pelvis.The reexamination after puerperal period of all the recipients showed no abnormality,no rejection reaction,and no graft loss.All the 12 newborns were single birth,and 3 of them were low birth weight infant.There were no birth defects or malformations and all of them were artificial feeding.The age of the offspring was 18.3±13.2 months,and no abnormality in physical development,intelligence,learning ability and psychological development were observed.Conclusions:Under the collaborative management and close monitoring of the multidisciplinary team,choosing the right time of pregnacy,formulating individual treatment plans and terminating pregnancy at the right time can effectively improve the pregnancy safety of kidney transplant recipients.