• Successful pregnancy after simultaneous pancreas-kidney transplantation:a case report

      Smyth, A; Gaffney, G; Hickey, D; Lappin, D; Redden, D; Dunne, F; Departments of Endocrinology, Obstetrics & Gynaecology and Nephrology, Galway University Hospitals, Galway, Ireland; Department of Urology & Transplantation, Beaumont Hospital, Dublin 9, Ireland. (Diabetic Pregnancy Study Group, 2011)
      The effect of pregnancy on simultaneous kidney pancreas transplant recipients has previously been described, but experience is limited. Compared to kidney transplant recipients, these patients experience higher rates of preterm delivery, low birth weight, hypertension, infection, pre-eclampsia, acute rejection and graft loss in later years. Risks are reduced by planning pregnancy with functional grafts and stable immunosuppression doses. We describe the case of a thirty-five year old female who six years previously underwent simultaneous kidney pancreas transplant. She had preceding type 1 diabetes mellitus for nineteen years, complicated by retinopathy and nephropathy that required haemodialysis. She also had polycystic ovarian syndrome and required hormonal support to achieve pregnancy. Immunosuppression included tacrolimus, prednisolone and mycophenolate mofetil which was changed to azathioprine prior to pregnancy. An integrated multidisciplinary team closely followed progress during pregnancy. She developed pregnancy-induced hypertension requiring labetolol. Tacrolimus doses were adjusted based on trough levels and blood glucose levels and HbA1c remained within normal limits. She did not require insulin treatment at any point and there was no deterioration in retinopathy despite progressive hypertension. She experienced deterioration in renal indices at twenty-six weeks gestation. Intramuscular betamethasone was administered. Due to further deterioration in renal indices delivery was planned and she underwent an uncomplicated, elective Caesarian section at thirty weeks gestation, performed by her obstetrician with assistance from her transplant surgeon. She delivered a male infant of 1.18kg, appropriate for gestational age, who had hypothermia and respiratory distress, which required intubation and ventilation and an eleven week stay in the special care baby unit. At eighteen month follow the infant shows normal development and there has been no deterioration in either graft’s function.