Pregnancy after pancreas-kidney transplantation
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REVIEW
Pregnancy after pancreas‑kidney transplantation Amelia Caretto1,2 · Rossana Caldara3 · Maria Teresa Castiglioni4 · Marina Scavini1,2 · Antonio Secchi3,5 Received: 25 April 2020 / Accepted: 7 September 2020 © Italian Society of Nephrology 2020
Abstract A combined kidney and pancreas transplant is a therapeutic option for patients with type 1 diabetes and end-stage renal disease. After successful transplantation, fertility is rapidly restored, allowing women of childbearing age to have spontaneous pregnancies and men to father pregnancies. These pregnancies are at increased risk for maternal and neonatal adverse outcomes due to immunosuppressive therapy, comorbidities, previous type 1 diabetes and previous transplant surgery, although the majority ends with the birth of a live and healthy offspring. Hypertension, miscarriages, diabetes, infections, graft rejections, preterm delivery and low birth weight may complicate pregnancies after pancreas-kidney transplantation. Since not all immunosuppressive drugs can be safely used in pregnancy, it is important to review immunosuppressive treatment before conception. Adequate pre-conception counseling is important to inform women and their partners about potential risks for the pregnancy and the grafts and the advantages of pregnancy planning. These pregnancies should be managed within a multidisciplinary team, comprising a transplant physician, an endocrinologist, a nephrologist, an obstetrician and a neonatologist. Last but not least, it is very important to continue collecting data on the pregnancies in pancreas-kidney transplantation with the aim to improve knowledge and to generate evidence-based guidelines for the care of women after pancreas-kidney transplants who are considering a pregnancy. Keywords Pregnancy after transplantation · Pancreas transplantation · Kidney transplantation · Immunosuppressive therapy · Pregnancy planning · Pregnancy in kidney donor
Introduction End stage renal disease (ESRD) is a potential, severe complication of type 1 diabetes (T1D), with a significant impact on all aspects of patients’ lives, including fertility. Although the risk of ESRD has decreased over recent years, among women with T1D the cumulative incidence of ESRD 30 years after diabetes onset is about 6% [1]. In patients with * Marina Scavini [email protected] 1
Department of Internal Medicine, Diabetes and Metabolism, San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy
2
Diabetes Research Institute, San Raffaele Scientific Institute, Milan, Italy
3
Clinical Transplant Unit, San Raffaele Scientific Institute, Milan, Italy
4
Department of Obstetrics and Gynecology, San Raffaele Scientific Institute, Milan, Italy
5
Vita-Salute San Raffaele University, Milan, Italy
diabetes and ESRD pancreas-kidney (PK) transplant restores renal function and endogenous insulin production and slows the progression of micro- and macrovascular complications, including the recurrence of diabetic nephropathy [2]. Furthermore, according to recentl
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