Twin pregnancy after kidney transplantation: case report and systematic review

Abstract Background: Kidney transplantation is associated with fertility restoration in more than 50% of women with chronic kidney disease. Pregnancy after transplantation may affect women’s health and fetal development, with higher rates of abortion, fetal growth restriction, and neonatal deaths. Twin pregnancy is a condition of high-risk for adverse maternal and perinatal outcomes, and its occurrence in women with previous kidney transplantation is rare. Case: 32-year-old woman, recipient of living donor kidney transplantation, with a history of one pregnancy prior to transplantation, with current normal allograft function and no use of contraceptive method. At ten weeks of amenorrhea, ultrasound investigation showed a dichorionic diamniotic twin pregnancy. The following evaluation showed Chiari type II features in one fetus, and no detectable abnormality in the other one. There was appropriate blood pressure control with no need for an antihypertensive drug, and renal function remained normal without proteinuria. Calcium and a low dose of acetylsalicylic acid were used as preeclampsia prophylaxis. At 33 weeks of gestation, she presented premature rupture of membranes with spontaneous preterm labor. A cesarean section was performed due to the breech presentation of the first fetus. The patient persisted with normal graft function and without graft rejection during follow-up. Discussion and conclusion: Twin pregnancies after kidney transplantation are rare, and it is most frequently associated with preterm birth. We reported a successful twin pregnancy after kidney transplantation, with good perinatal and maternal outcomes, and without graft rejection or dysfunction.

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Laparoscopic-Assisted Recipient Nephrectomy and Recipient Kidney Procurement during Orthotopic Living-Related Kidney Transplantation

Case Reports in Transplantation ◽

10.1155/2011/153493 ◽

2011 ◽

Vol 2011 ◽

pp. 1-4 ◽

Cited By ~ 1

Author(s):

Dimitri Mikhalski ◽

Karl Martin Wissing ◽

Renaud Bollens ◽

Daniel Abramowicz ◽

Vincent Donckier ◽

...

Keyword(s):

Kidney Transplantation ◽

Antiphospholipid Antibodies ◽

Graft Function ◽

Renal Vessels ◽

Short Period ◽

History Of ◽

Stage Renal Disease ◽

End Stage ◽

Living Related ◽

Laparoscopic Assisted

Advanced atherosclerosis or thrombosis of iliac vessels can constitute an absolute contraindication for heterotopic kidney transplantation. We report the case of a 42-year-old women with end-stage renal disease due to lupus nephritis and a history of bilateral thrombosis of iliac arteries caused by antiphospholipid antibodies. Occlusion had been treated by the bilateral placement of wall stents which precluded vascular anastomosis. The patient was transplanted with a right kidney procured by laparoscopic nephrectomy from her HLA semi-identical sister. The recipient had left nephrectomy after laparoscopical transperitoneal dissection. The donor kidney was orthotopically transplanted with end-to-end anastomosis of graft vessels to native renal vessels and of the graft and native ureter. Although, the patient received full anticoagulation because of a cardiac valve and antiphospholipid antibodies, she had no postoperative complication in spite of a short period of delayed graft function. Serum creatinine levels three months after transplantation were at 1.0 mg/dl. Our case documents that orthotopical transplantation of laparoscopically procured living donor kidneys at the site of recipient nephrectomy is a feasible procedure in patients with surgical contraindication of standard heterotopic kidney transplantation.

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Perinatal outcomes in adolescent pregnancy

Journal of Chitwan Medical College ◽

10.3126/jcmc.v8i2.23734 ◽

2018 ◽

Vol 8 (2) ◽

pp. 27-31

Author(s):

Yam Prasad Dwa ◽

Sunita Bhandari ◽

Devendra Shrestha ◽

Ajaya Kumar Dhakal

Keyword(s):

Adolescent Pregnancy ◽

Perinatal Asphyxia ◽

Mode Of Delivery ◽

Perinatal Outcomes ◽

Breech Presentation ◽

Fetal Distress ◽

Neonatal Deaths ◽

Medical College ◽

Adolescent Women ◽

Pregnant Adolescent

Introduction: Adolescent pregnancy is prevalent in Nepal and bears significant consequences to both mother and newborn. Methods: All pregnant women aged 19 years or less who were admitted for delivery at KIST Medical College during 14th April 2017 to 15th July 2018 were included in this study. Maternal and immediate neonatal outcomes were analyzed retrospectively from their medical records. Results: There were 135 pregnant adolescent women out of 1300 deliveries. Preeclampsia was observed in 2 pregnancies. Vaginal delivery (99; 73.3%) was the predominant mode of delivery. Emergency LS CS was performed in 35 (25.9%) deliveries and most frequent indications for LS CS were nonprogress of labor (8/35), breech presentation (8/35) and fetal distress (6/35). 10 (7.4%) babies were born preterm. 23 (17%) babies were born low birth weight. 37 (27.4%) neonates were symptomatic and required neonatal admission. Respiratory distress was the most frequent neonatal problem (29; 21.5%), followed by neonatal sepsis (18; 13.3%) and perinatal asphyxia (9; 6.7%). There were 3 (2.2%) still birth and 2 (1.5%) early neonatal deaths. Conclusion: Adolescent pregnancy was common and associated with increased early neonatal problems.

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50-year history of kidney transplantation in Hungary

Orvosi Hetilap ◽

10.1556/oh.2013.29649 ◽

2013 ◽

Vol 154 (22) ◽

pp. 846-849 ◽

Cited By ~ 3

Author(s):

Edit Szederkényi ◽

Pál Szenohradszky ◽

Ernő Csajbók ◽

Ferenc Perner ◽

László Asztalos ◽

...

Keyword(s):

Kidney Transplantation ◽

Kidney Transplant ◽

Graft Rejection ◽

Full Membership ◽

Ministry Of Health ◽

The Past ◽

Transplant Program ◽

History Of ◽

Patient Groups ◽

Special Patient

The first Hungarian kidney transplantation was performed by András Németh in Szeged in 1962, approximately 50 years ago. A preliminary agreement with Eurotransplant was signed in 2011, and special patient groups gained benefit from this cooperation in 2012, wnich lead to a full membership to Eurotransplant. This event inspired the authors to review the history of Hungarian kidney transplantation of the past 50 years, from the first operation to recent via the specific cornerstones of the transplant program. The donor of the first Hungarian kidney transplantation was the brother of the recipient. The operation itself was technically successful, but the lack of immunosuppression caused graft rejection, and the patient died after 79 days. His brother, the donor, is still healthy, after 50 years, and he encourages everybody to donate organs. Organized kidney transplant program started more than 10 years later, such as 1973, in Budapest. The program was supported by the Ministry of Health. New centers joined the program later, Szeged in 1979, Debrecen in 1991 and Pécs in 1993. These four transplant centers work currently in Hungary, and 6611 kidney transplantation has been performed up to the end of year 2012. Orv. Hetil., 2013, 154, 846–849.

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Kidney transplantation after rescue allocation—meticulous selection yields the chance for excellent outcome

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa286 ◽

2020 ◽

Author(s):

Volker Assfalg ◽

Svea Misselwitz ◽

Lutz Renders ◽

Norbert Hüser ◽

Alexander Novotny ◽

...

Keyword(s):

Kidney Transplantation ◽

Patient Survival ◽

Graft Function ◽

Outcome Data ◽

Organ Donors ◽

Excellent Outcome ◽

Expanded Criteria Donor ◽

History Of ◽

Criteria Catalogue ◽

Expanded Criteria

Abstract Background The small number of organ donors forces transplant centres to consider potentially suboptimal kidneys for transplantation. Eurotransplant established an algorithm for rescue allocation (RA) of kidneys repeatedly declined or not allocated within 5 h after procurement. Data on the outcomes and benefits of RA are scarce to date. Methods We conducted a retrospective 8-year analysis of transplant outcomes of RA offers based on our in-house criteria catalogue for acceptance and decline of organs and potential recipients. Results RA donors and recipients were both older compared with standard allocation (SA). RA donors more frequently had a history of hypertension, diabetes or fulfilled expanded criteria donor key parameters. RA recipients had poorer human leucocyte antigen (HLA) matches and longer cold ischaemia times (CITs). However, waiting time was shorter and delayed graft function, primary non-function and biopsy-proven rejections were comparable to SA. Five-year graft and patient survival after RA were similar to SA. In multivariate models accounting for confounding factors, graft survival and mortality after RA and SA were comparable as well. Conclusions Facing relevant comorbidities and rapid deterioration with the risk of being removed from the waiting list, kidney transplantation after RA was identified to allow for earlier transplantation with excellent outcome. Data from this survey propose not to reject categorically organs from multimorbid donors with older age and a history of hypertension or diabetes to aim for the best possible HLA matching and to carefully calculate overall expected CIT.

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P1643TORQUE TENO VIRUS FOR RISK STRATIFICATION OF SUBCLINICAL GRAFT REJECTION AFTER KIDNEY TRANSPLANTATION- A PROSPECTIVE STUDY

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa142.p1643 ◽

2020 ◽

Vol 35 (Supplement_3) ◽

Author(s):

Konstantin Doberer ◽

Georg A Böhmig ◽

Elisabeth Puchhammer-Stöckl ◽

Gregor Bond

Keyword(s):

Kidney Transplantation ◽

Graft Rejection ◽

Graft Function ◽

Type I ◽

Kidney Graft ◽

Protocol Biopsy ◽

Patients At Risk ◽

Subclinical Rejection ◽

High Level ◽

A Prospective Study

Abstract Background and Aims Non-invasive monitoring strategies are insufficient to detect patients at risk for subclinical graft rejection after kidney transplantation. The highly prevalent and non-pathogenic Torque Teno virus (TTV) reflects the immunocompetence of its host: high level viraemia indicates strong and low level viraemia weak immunosuppression, respectively. Thus TTV replication might serve as a candidate for immunologic monitoring. Method To analyze the association between TTV and subclinical kidney graft rejection, an interim analysis of the prospective “TTV POET” cohort study (DRKS00012335) was performed including data available until 31/01/2019. All consecutive kidney graft recipients transplanted at the Medical University Vienna since 01/12/2016 (n=308) with a protocol biopsy 12 months after transplantation (n=47; median 12.4 months) and stable graft function were included. Biopsy results according to current BANFF classification were analyzed in the context of peripheral blood TTV levels quantified by PCR. Results Graft function was excellent (median eGFR MDRD: 57 ml/min/1.73m2, urinary PKR: 92 mg/g). Twenty recipients (43%) had subclinical rejection (borderline TCMR, n=16; ABMR, n=3; TCMR type I, n=1). TTV level quantified at the date of biopsy was lower in recipients with rejection compared to recipients without rejection. The risk for rejection increased by 11% with each log level decrease in TTV copies/ml (RR 0.89, 95% CI 0.85-0.93; p<0.001). Differences in TTV levels were evident not only at the date of biopsy, but already 6 weeks earlier. Patients with biopsies showing chronic leasons, suggesting ongoing allo-reactivity, had a longer period of time with TTV levels <1x106 copies/ml. Conclusion Our data suggests an association between TTV level and subclinical graft rejection at 12 months after kidney transplantation. Future clinical trials are necessary to test the potential of TTV guided immunosuppression to reduce subclinical rejection.

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Fetal malposition and malpresentation: Mode of delivery and perinatal outcomes at Maternity Teaching Hospital in Erbil city

Zanco Journal of Medical Sciences ◽

10.15218/zjms.2020.044 ◽

2020 ◽

Vol 24 (3) ◽

pp. 367-375

Author(s):

Shahen Kak Hussein ◽

Shahla Alalaf

Keyword(s):

Cesarean Section ◽

Teaching Hospital ◽

Neonatal Intensive Care ◽

Mode Of Delivery ◽

Perinatal Outcomes ◽

Breech Presentation ◽

Neonatal Morbidity ◽

Cross Sectional Study ◽

Cross Sectional ◽

Neonatal Deaths

Background and objective: Delivering a malpositioned and malpresenting fetus remains uncertainty, despite advances in obstetric practice. This study aimed to determine the mode of delivery and neonatal outcome in cases of fetal malposition and malpresentation. Methods: A cross-sectional study of women delivering malpositioned and malpresenting fetuses was conducted at Maternity Teaching Hospital, Erbil city, Kurdistan Region, Iraq, from the 1st of June, to the 30th of November, 2018. Three hundred women and their newborns were followed for seven days of life. Results: The total rate of malposition and malpresentation was 4.8%. Most women (87.3%) delivered by cesarean section, 25% of the neonates were admitted to the neonatal intensive care unit, where 69.3% of these infants stayed for seven days. There were three early neonatal deaths (1.0%), all of them were in occipito-posterior, or occipito-transverse position and were delivered abdominally. Among occipito-posterior and occipito-transverse deliveries, 2.2% ended with the death of the fetus (P = 0.360). An Apgar score of 7 was recorded after 5 minutes for 97.7% of the infants. Around 11% of the women had postpartum hemorrhage. Conclusion: Fetal malpresentation and malposition are not uncommon during labor, and most cases are delivered by cesarean section. Neonatal morbidity and mortality are dependent on the type of presentation and the mode of delivery. Keywords: Malposition; Malpresentation; Perinatal outcome; Breech presentation.

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P1717OUTCOMES OF INCREASED INTRA-ABDOMINAL PRESSURE AFTER KIDNEY TRANSPLANTATION

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa142.p1717 ◽

2020 ◽

Vol 35 (Supplement_3) ◽

Author(s):

Armando Coca ◽

Carlos Arias-Cabrales ◽

Maria José Pérez-Sáez ◽

Pablo Gonzalez ◽

Isabel Acosta-Ochoa ◽

...

Keyword(s):

Kidney Transplantation ◽

Graft Failure ◽

Graft Function ◽

Delayed Graft Function ◽

Donation After Cardiac Death ◽

Abdominal Pressure ◽

Kidney Transplant Recipients ◽

Abdominal Hypertension ◽

History Of ◽

Recipient Age

Abstract Background and Aims Increased intra-abdominal pressure (IAP) is commonly found among post-surgical patients and can induce organ dysfunction. However, its prevalence and impact after kidney transplantation have not been adequately described. We aimed to study the prevalence of increased IAP after kidney transplantation and its consequences on transplant outcomes. Method IAP was prospectively measured in 121 kidney transplant recipients every 8h during the first 72h after surgery using the urinary bladder technique (UnoMeter Abdo-Pressure kit). Mean IAP values during the first 24h (24h-IAP) were used in this analysis. Grading of intra-abdominal hypertension was defined according to WSACS guidelines. Patients were followed for at least 12 months or until graft failure or death. The study was approved by the local ethics committee and informed consent was obtained in all cases. Results 24h-IAP was 12.6±3.5 mmHg. 84.2% of subjects presented with intra-abdominal hypertension during the first 72h after kidney transplantation. Body mass index (OR: 1.35, 95% CI 1.12-1.63; P=0.002), male sex (OR: 3.34, 95% CI 1.1-10.3; P=0.032) and hemodialysis as renal replacement therapy before transplantation (OR: 4.35, 95% CI 1.32-14.4; P=0.016) were independent determinants of intra-abdominal hypertension. IAP was an independent risk factor for delayed graft function (*model adjusted for recipient age, sex, history of previous kidney transplants, recipient comorbidities, donor terminal serum creatinine and comorbidities, number of HLA mismatches >4, cold ischemia time and donation after cardiac death status), graft failure and death (**model adjusted for all variables included in the previous model plus delayed graft failure) (Figure). Conclusion Increased IAP was highly common after transplant surgery and was associated with higher rates of delayed graft function, graft failure and death. Routine IAP monitoring should be considered after transplantation to facilitate early identification of complications and initiation of the appropriate treatment to stop its effects.

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Pregnancy Among Women with Kidney Transplantation: A 20-Years Single-Center Registry

Revista Brasileira de Ginecologia e Obstetrícia / RBGO Gynecology and Obstetrics ◽

10.1055/s-0039-1688834 ◽

2019 ◽

Vol 41 (07) ◽

pp. 419-424

Author(s):

Stephanye Mariano ◽

Jose Paulo de Siqueira Guida ◽

Marcos Vinicius de Sousa ◽

Mary Angela Parpinelli ◽

Fernanda Garanhani Surita ◽

...

Keyword(s):

Blood Pressure ◽

Renal Function ◽

Kidney Transplantation ◽

Cesarean Section ◽

Graft Function ◽

Perinatal Outcomes ◽

Time Interval ◽

Pregnancy And Postpartum ◽

Tertiary Center ◽

The Mean

Objective To assess maternal and perinatal outcomes in pregnancies after kidney transplantation in a tertiary center in Brazil. Methods Retrospective cohort of pregnancies in women with kidney transplantation at the Universidade Estadual de Campinas, from January 1995 until December 2017. Medical charts were reviewed, and maternal and perinatal outcomes were described as means and frequencies. Renal function and blood pressure were evaluated during pregnancy and postpartum. Results A total of 22 women had at least 1 pregnancy during the considered time interval, and 3 of them had > 1 pregnancy, totalizing 25 pregnancies. The mean age at transplantation was of 24.6 ± 4.2 years old, and the mean time interval until pregnancy was of 67.8 ± 46.3 months. The most frequent complication during pregnancy was hypertension, which affected 11 (64.7%) women. The gestational age at delivery was 34.7 ± 4 weeks, and 47% of these pregnancies were preterm (< 37 weeks). A total of 88.2% of the women delivered by cesarean section. Renal function, measured by serum creatinine, remained stable during pregnancy, and the systolic blood pressure increased significantly, while the diastolic blood pressure did not differ during pregnancy. Conclusion Pregnancy after kidney transplantation is a rare event. Pre-eclampsia and prematurity were frequent complications, and cesarean section rates were very high. A specialized antenatal and postpartum care with a multiprofessional approach and continuous monitoring of graft function are essential for the early diagnosis of complications and improved outcomes.

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Intra-abdominal hypertension in early post-kidney transplantation period is associated with impaired graft function

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa104 ◽

2020 ◽

Vol 35 (9) ◽

pp. 1619-1628

Author(s):

Vincent Dupont ◽

Alexandre Debrumetz ◽

Adrien Leguillou ◽

David Morland ◽

Alain Wynckel ◽

...

Keyword(s):

Kidney Transplantation ◽

Venous Pressure ◽

Previous History ◽

Graft Function ◽

University Hospital ◽

Abdominal Pressure ◽

Function Recovery ◽

Abdominal Hypertension ◽

History Of ◽

The University

Abstract Background Moderate hyperhydration is often achieved in the early post-kidney transplantation period. Whether this strategy could lead to the development of intra-abdominal hypertension (IAH) has never been assessed so far. We aimed to study the incidence of IAH after kidney transplantation and its association with graft function recovery. Methods We conducted a prospective monocentric study among patients undergoing kidney transplantation at the University Hospital of Reims between May 2017 and April 2019. Intravesical pressure (IVP) was monitored every 8 h from Day 0 to 3. Results A total of 107 patients were enrolled. Among 55 patients included in the analysis, 74.5% developed IAH. Body mass index >25 kg/m2 was associated with IAH development {odds ratio [OR] 10.4 [95% confidence interval (CI) 2.0–52.9]; P = 0.005}. A previous history of peritoneal dialysis was protective [OR 0.06 (95% CI 0.01–0.3); P = 0.001]. IAH Grades III and IV occurred in 30.9% of patients and correlated with higher Day 3 creatininaemia (419.6 ± 258.5 versus 232.5 ± 189.4 μmol/L; P = 0.02), higher delayed graft function incidence (41.2 versus 7.9%; P = 0.04), lower Kirchner index measured using scintigraphy (0.47 ± 0.09 versus 0.64 ± 0.09; P = 0.0005) and decreased Day 30 estimated glomerular filtration rate (35.8 ± 18.8 versus 52.5 ± 21.3, P = 0.05). IAH patients had higher fluid balance (P = 0.02). Evolution of IVP correlated with weight gain (P < 0.01) and central venous pressure (P < 0.001). Conclusions IAH is frequent after kidney transplantation and IAH Grades III and IV are independently associated with impaired graft function. These results question current haemodynamic objectives and raise for the first time interest in intra-abdominal pressure monitoring in these patients. Clinical Trial Notation ClinicalTrials.gov identifier: NCT03478176

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MO931PRETRANSPLANT ANGIOTENSIN II TYPE 1 RECEPTOR ANTIBODIES INFLUENCE GRAFT FUNCTION BUT NOT GRAFT SURVIVAL AT 1 YEAR AFTER KIDNEY TRANSPLANTATION IN A LOW IMMUNOLOGICAL RISK COHORT

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfab110.0010 ◽

2021 ◽

Vol 36 (Supplement_1) ◽

Author(s):

Bogdan Marian Sorohan ◽

Andreea Ioana Berechet ◽

Bogdan Obrisca ◽

Ileana Constantinescu ◽

Ionut Maruntelu ◽

...

Keyword(s):

Regression Analysis ◽

Kidney Transplantation ◽

Angiotensin Ii ◽

Graft Rejection ◽

Graft Failure ◽

Cox Regression ◽

Graft Function ◽

Receptor Antibodies ◽

Independent Determinant

Abstract Background and Aims Angiotensin II type 1 receptor antibodies (AT1R-Ab) are associated with graft rejection and poor graft outcomes in kidney transplantation (KT). It has been shown that AT1R-Ab have a negative impact on both short-term and long-term graft function, even in the absence of rejection, but this has not been confirmed by other studies. Our aim was to assess the frequency of pretransplant AT1R-Ab and to determine their influence on graft function and survival at 1 year after KT. Method We performed a prospective, observational cohort study in 67 adult KT recipients, transplanted between October 2018 and October 2019. Clinical, biological and immunological data of the recipients, age, gender and type of donor, transplant and immunosuppression parameters were collected at the moment of transplantation. A cut-off > 10 U/mL was used for AT1R-Ab detection. Results Among the 67 recipients mean age was 41.3 ± 10.3 years, male gender was predominant (59.7%) and the main known cause of end-stage renal disease was glomerular disease. Six patients out of 67 (9%) had a previous kidney transplant. The donor mean age was 50 ± 15.5 years and 65.7% of patients received the kidney graft from a cadaveric donor. Pretransplant AT1R-Ab were detected in 7 out of 67 patients (10.4%) and none of the patients had specific antibodies against human leucocyte antigen. After 1 year of follow-up, median estimated glomerular filtration rate (eGFR) of the recipients was 54 ml/min/1.73 m2 (40.6 – 65.9), 10.4% of patients developed delayed graft function, 7.5% had graft failure and no cases of biopsy proven graft rejection or death was reported. Patients with pretransplant AT1R-Ab had a significant reduced graft function at 1 year after KT compared to those without antibodies [35 (29.8- 55.2) vs 56.1 (41.3 – 66.5) ml/min, p=0.02]. After multivariate linear regression analysis, pretransplant AT1R-Ab were an independent determinant of eGFR at 1 year after KT (β: -14.066; 95% CI: -27.44 - -0.68; p=0.04). Cox regression analysis was used to assess the association of AT1R-Ab along with other clinical, biological and immunological parameters with graft failure. Neither the univariate (HR= 2.07, 95% CI: 0.23-18.52, p=0.51) nor the multivariate (HR= 1.36, 95% CI: 0.10-14.09, p=0.80) Cox regression models showed that pretransplant AT1R-Ab were an independent predictor for graft loss. Conclusion We showed that pretransplant AT1R-Ab are an independent determinant of graft function but do not influence the graft survival at 1 year after transplantation in a prospective low immunological risk cohort of kidney transplant recipients.

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