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Transcript of RENALE. INDAGINE CONOSCITIVA DEL GdS : DATI · PDF filerenale. indagine conoscitiva del gds :...

GRAVIDANZA DOPO TRAPIANTO RENALE. INDAGINE

CONOSCITIVA DEL GdS : DATI PRELIMINARI

Pierluigi Di Loreto MD PhDNephrology Dialysis Transplantation Unit

San Bortolo Hospital Vicenza Italy

TAORMINA,15-16 Aprile 2011

Gruppo di StudioTRAPIANTO DI RENE E RENE PANCREAS

Indagine conoscitiva sulla gestione della gravidanza nelle donne portatrici di

trapianto renale.

Valutazione della gravidanza nelle donne portatrici di trapianto

renale.

ANAMNESI MATERNA PRIMA DEL TRAPIANTO DI RENE

COD PZ TIPO DI NEFROPATIA

ETA AD INZIO DIALISI

METODICADIALITICA

IPERTEN. ART.

DIABETE MELLITO

prima 3 lettere nome +

prime 3 lettere

cognome+(gg+mm+anno)

di nascita

Esempio: Iliara Balbo nata il

01/01/1974

Cod paz ILABAL010174

1: Glomerulonefriti

2: Nefropatia diabetica

3: Nefroangiosclerosi

4: Rene policistico

5: Nefropatia tubulo-

interstiziale

6: Nefropatia ostruttiva

7: IgA nefropatia

8: Altro

1: HD

2: PD

0: assente

1: presente

ANAMNESI MATERNA LEGATA AL TRAPIANTO DI RENE PRIMA DELLA

GRAVIDANZA

1:cadavere

2: vivente (mg/dl)

0: assente

1: presente

DONATORE CREAT PRIMA GRAV

STEROIDE AZA INIBITORI CALCINEURINE

MMF SIROLIMUS

EVEROLIMUS

ANAMNESI MATERNA REALTIVA ALLA GRAVIDANZA

0: assente

1: presente

ETA MATERNA

MESI FRA TX E GRAV

STEROIDE CSA AZA TACROLIMUS

PROFILASSICON ASPIRINETTA

1: via vaginale

2: taglio cesario

1: preeclampsia

2: ipertensione arteriosa

3: IRA (aumento creat >25%)

4: proteinuria

5: distacco di placenta

6: perdita del graft

7: IVU

8: aborto spontaneo

7: altro

OUTCOME MATERNO

CREATATTORNO A 20 WG

COMPLICANZE MATERNE

PARTO CREAT AL 6 MESE DOPO IL PARTO

CREAT AD 1 AA DOPO IL PARTO

ULTIMA CREAT DISPONIBILE

ULTIMA PROTEINURIADISPONIBILE

OUTCOME FETALE

1: nato a termine

2: nato pretermine

3: SGA

settimane

gr1 IUGR

2 ARDS

3 S di

Klinefelter

4 nascita

pretermine

5 altro

OUTCOME FETALE

ETA GESTAZIONALE

PESO ALLA NASCITA

COMPLICANZE FETALI

APGAR AL 6

APGAR AL9

CRITERIA FOR CONSIDERING PREGNANCY

IN RENAL TRANSPLANT RECIPIENTS

Good general health for about 2 years after transplantation Good stable allograft function (Serum Cr < 2 mg/die), preferably

MATERIALS AND METHODS

Retrospective study including all pregnantwomen transplanted

Variables analyzed: Type of nephropathy

Patient age when dialysis began, at tx, at pre.cy

Time between dialysis and tx, between tx and childbirth

Immunosuppressive theraphy

Mother and fetal complications

Type of delivery

Baby weight and Apgar score

Baby and mother follow up

R E S U L T S

N of Patients

Type of nephropathy

31

6 Chronic Pielonephritis1 Post Partum Cortical Necrosis4 IgA Nephropathy3 Diabetic Nephropathy9 Unknown Nephropathy1 ADPKD2 Nephroang.sis5 GN

RESULTS II

PT Age at Start of HD (Y)

PT Age at TX (Y)

PT Age at Pregnancy (Y)

Time between HD-TX (M)

Time between Tx-Childbirth

Cadaver Donor

Living donor

N OF Pregnancies

HBP before Pre.cy

Immunos.ve Theraphy

28,05 (SD 2,35)

30,25 (SD 2,52)

33,9 (SD 3,1)

16 (SD 22,3)

4,45 (SD 3,15)

29

02

32

19

18 Pred.ne, CyA, AZA

06 FK, Prednisone

07 Prednisone, CyA

MATERNAL RENAL FUNCTION

BEFORE PREGNANCY: Creat= 1.1 0.115 mg/dl DURING PREGNANCY: Creat= 0.9 0.1 mg/dl AFTER PREGNANCY: Creat= 1.09 0.125 mg/dl

MOTHER COMPLICATIONS DURING PREGNANCY

SA2

NNP4

PE4

IPD1

UTI5

HBP1

AR2

OTHER2

OBSTETRIC DATA

MODE OF DELIVERY

APGAR INDEX CHILDBIRTHS TERMBIRTH PRETERM BIRTH SGA GESTATIONAL AGE (W) BABY WEIGHT (G) INTENSIVE CARE BREASTFEEDING

CAESAREAN 99% VAGINAL 1%

Between 4/8 and 6/9 30 8 22 2 35,4 (SD 3,15) 2350 (SD 890) 5 BABIES 0

FOETAL COMPLICATIONS

IUGR2

ADRS1

KLINEFELTER SYNDROME1

MOTHER FOLLOW UP

ACUTE REJECTION GRAFT LOSS WITHIN 2 Y KIDNEY FUNCTION (sCr) PROTEINURIA ABSENT PROTEINURIA >0,3 gr/die RAS BLOCKERS ARB + CALCIUM ANT.STS

0 0 1,09 mg/dl (SD 0,125) 22 PTS 09 PTS 13 PTS 09 PTS

BABY FOLLOW UP

ANY SIGNIFICANT DISEASE

DATA FROMNTPR, EDTA, U.K.TR.PRE.RE., ISN

Live birthMiscarriageTherapeutic Termination(

MOTHER-FETAL COMPLICATIONS

INFECTIONS TRANSIENT REDUCTION OF

RENAL FUNCTION

PE PROTEINURIA HIGH BLOOD PRESSURE GRAFT LOSS WITHIN 2 YEARS

FROM DELIVERY

INTERNAL PLACENTA DETACHMENT

UREMIC EMOLITIC SINDROME DIABETES ACUTE REJECTION NON IMMUNOLOGICAL

KIDNEY DISFUNCTION

RESPIRATORY DISTRESS INFECTIONS SURRENAL INSUFFICIENCY LYMPHOCITE CHROSOME

DEFECTS

LEUCOPENIA-ANEMIA THROMBOCYTOPENIA HYDRONEPHROSIS MALFORMATIONS

MO T H E R F E T A L

MOTHER COMPLICATIONS

HIGH BLOODPRESSURE

70%

INFECTIONS25%

PE30%

NON IMM. KIDNEY DIS.TION12%

AR9%

PE (%) IN RTR AND NON RTR

0

5

10

15

20

25

30

35

RTR NON RTR

GRAFT LOSS (%) WITHIN TWO YEARS FROM DELIVERY IN RTR

0

2

4

6

8

10

12

14

16

18

SCr>2.5 mg/dl SCr

MORTALITY

MOTHER Not affected from tx

PERINATAL 10%

MOTHER - BABY FOLLOW UP

LONG TERM RENAL FUNCTION NOT AFFECTED FROM PREGNANCY (Mother)

NORMAL GROWTH 95%

REQUIRED EDUCATIONAL SUPPORT 16% 11% GENERAL POPULATION

CONCLUSIONS

OUR DATA ARE IN AGREEMENT WITH THOSE OF THE LITERATURE

PREGNANCY AFTER KIDNEY TRANSPLANT, ALTHOUGH POSSIBLE, CARRIES AN ELEVATED RISK AND THEREFORE PATIENTS HAVE TO BE REFERRED TO HIGHLY SPECIALIZED CENTERS

PREGNANCY IS NOT WITHOUT RISKS AS IN A DIFFICULT JUMP; WHAT IS IMPORTANT EXACTLY AS BEFORE A JUMP IS TO LOOK BEFORE YOU LEAP