Jornal brasileiro de nefrologia · 2026
Pregnancy and kidney transplantation: optimized clinical and obstetric management to reduce maternal and perinatal complications.
СтатьяОбзорНазвание и аннотация: Перевод в очереди
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Santos Annie Caroline Magalhães, Freitas Rogério Caixeta Moraes de, Kahhale Soubhi, Francisco Rossana Pulcineli Vieira, Galletta Marco Aurélio Knippel
Аннотация
OBJECTIVE: Review the literature to provide guidance on the appropriate clinical and obstetric management of pregnant women with kidney transplants to reduce maternal and perinatal complications.
METHODS: The PubMed and SciELO databases, which evaluated pregnancy and kidney transplantation, were searched, focusing on clinical and obstetric management. Other variables of interest were preconception counseling, fertility, the safety of immunosuppressants, maternal complications, perinatal complications, graft worsening during pregnancy, and postpartum guidance.
RESULTS: A total of 354 articles were identified, of which 76 were included in the analysis. Studies suggest that attempts to conceive should begin at least one year after kidney transplantation in the absence of graft rejection, with stable renal function (creatinine < 1.5 mg/dL and minimal proteinuria < 500 mg/24 h), with adjustment of the class and dose of immunosuppressants (preferably corticosteroids, azathioprine, cyclosporine, tacrolimus, and hydroxychloroquine). Preeclampsia prophylaxis with acetylsalicylic acid (81-50 mg/night) and calcium (1-1.5 g/day) should be universal in this group. Monitoring of renal function, fetal growth, and fetal vitality must be frequent.
CONCLUSION: Pregnancy in kidney transplant recipients is challenging due to maternal and perinatal risks. However, the present review demonstrates that clinical and obstetric management by an experienced multidisciplinary team contributes to better maternal and perinatal outcomes in pregnancies among kidney transplant recipients.
METHODS: The PubMed and SciELO databases, which evaluated pregnancy and kidney transplantation, were searched, focusing on clinical and obstetric management. Other variables of interest were preconception counseling, fertility, the safety of immunosuppressants, maternal complications, perinatal complications, graft worsening during pregnancy, and postpartum guidance.
RESULTS: A total of 354 articles were identified, of which 76 were included in the analysis. Studies suggest that attempts to conceive should begin at least one year after kidney transplantation in the absence of graft rejection, with stable renal function (creatinine < 1.5 mg/dL and minimal proteinuria < 500 mg/24 h), with adjustment of the class and dose of immunosuppressants (preferably corticosteroids, azathioprine, cyclosporine, tacrolimus, and hydroxychloroquine). Preeclampsia prophylaxis with acetylsalicylic acid (81-50 mg/night) and calcium (1-1.5 g/day) should be universal in this group. Monitoring of renal function, fetal growth, and fetal vitality must be frequent.
CONCLUSION: Pregnancy in kidney transplant recipients is challenging due to maternal and perinatal risks. However, the present review demonstrates that clinical and obstetric management by an experienced multidisciplinary team contributes to better maternal and perinatal outcomes in pregnancies among kidney transplant recipients.