Dr Erin Clark
Women's & Children's Hospital, A


Title: Two Pregnancies Within 5 Years Of Simultaneous Pancreas-Kidney Transplantation: A Case Report

Authors: Fadak Mohammadi1 2, Stephen McDonald 1 2 , Erin Clarke 3, Shilpanjali Jesudason1 2

1 Central and Northern Adelaide Renal and Transplantation Services (CNARTS), Royal Adelaide Hospital, Adelaide, South Australia
2 Department of Medicine, University of Adelaide, Adelaide, South Australia 
3 Women’s and Babies Division, Women’s and Children’s Hospital, Adelaide, Australia

Abstract Text: 

Simultaneous kidney-pancreas transplantation (KPT) can rapidly restore fertility in women with renal failure. There have been few cases of pregnancy after KPT, and a second pregnancy is rare. We report a case of two successful pregnancies within 2 years in a KPT recipient.

Case Report
At age 29, a Caucasian woman with type 1 diabetes mellitus commenced haemodialysis for severe diabetic nephropathy. Four months later, she underwent successful KPT, with baseline creatinine 96umol/L and insulin-independent pancreatic function. 

First pregnancy
Three years post-transplantation, pregnancy was achieved with in-vitro fertilization (IVF). Prior to pregnancy, immunosuppression was switched from mycophenolate to azathioprine, whilst continuing tacrolimus and prednisolone. Early pregnancy was complicated by lower urinary tract infection, but was otherwise uneventful. Severe pre-eclampsia developed at 34 weeks. Serum creatinine rose to 133umol/L with oliguria and severe hypertension, precipitating emergency caesarean section, delivering a healthy male weighing 2610g at the 40th growth centile. 

Second pregnancy
This pregnancy occurred naturally 8 months post-partum, with pre-conception serum creatinine 98umol/L and good pancreas function. The second pregnancy course was uneventful until 35 weeks gestation; she again developed pre-eclampsia with creatinine rise to 126umol/L, prompting caesarean section. She delivered a healthy female at 2520g, plotting at the 64th centile for birth weight. Serum creatinine was 99umol/L three months post-partum, with no new HLA-antibodies. Both babies were breastfed.

KPT with resulting stable pre-pregnancy allograft function enabled this patient to achieve successful pregnancy. However, both pregnancies were complicated by transient renal graft dysfunction and pre-eclampsia precipitating pre-term birth. The patient received close multi-disciplinary observation during both pregnancies.