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    Family Planning After Kidney Transplantation

    Transplantation Helps Restore Fertility for Women Wanting to Conceive

    Kidney transplantation offers many benefits to patients with end-stage renal disease (ESRD). These include an improvement in one’s quality of life, a greater ability to exercise, travel and work, and a sense of freedom not as easily achieved on dialysis. An additional benefit for female recipients is an enhanced ability to conceive a child.

    There are a variety of physiologic issues that lead to infertility in ESRD patients. Once transplanted, a woman of child-bearing years who has good transplant function may consider raising a family. In fact, reports show that more than 2,000 children have been born to transplant recipients.

    Transplant recipients thinking about starting a family have a number of issues to consider. First, transplant recipients contemplating pregnancy should be referred to a “high-risk” OB/GYN practice, preferably one with experience treating transplant patients. Although the frequency of transplant kidney dysfunction due to pregnancy is very low, significant consequences can result if this occurs.

    There are some basic recommendations that should be followed by women interested in considering pregnancy after their transplant:

    • Wait at least one to two years after transplantation while practicing effective birth control to avoid accidental pregnancy earlier in the post-transplant course. This period allows enough time for the kidney to stabilize and for the transplant team to safely reduce immunosuppressive drug doses.

    • Make sure that the kidney function is optimized, preferably with creatinine levels under 1.5 to 2 mg/dl.

    • Wait at least six to 12 months after an acute rejection episode.

    • Maintain excellent blood pressure control.

    • Review your medical regimen with your nephrologists or transplant physician, eliminating drugs that place the pregnancy at risk.
    “We recommend that patients make an appointment with their transplant team before attempting to conceive,” says Steven Katznelson, M.D., medical director of California Pacific’s Kidney Transplant Team. He adds, “Some adjustments in anti-rejection medications may be recommended as some of the newer transplant medications do not have a long track record in pregnant women.”

    Close monitoring by the transplant team is essential during pregnancy to monitor for any changes in transplant kidney function. In addition, pregnancy can cause more rapid metabolism of cyclosporine and prograf (two commonly used immunosuppressive agents), leading to inadequate drug levels and a higher risk of acute rejection. Thus, frequent monitoring of laboratories is essential to prevent any problems.

    Pregnancies in transplant recipients are usually relatively uneventful with excellent outcomes. Babies of transplant recipients are not prone to birth defects. There is a higher incidence of premature and low-birth weight babies, cesarean births and miscarriages among transplant patients as compared to the general population.

    Breastfeeding remains controversial for transplant recipients. As Katznelson explains, “There is some concern that the immunosuppressive drugs could affect the baby’s health through breast milk consumption.” Therefore, he recommends that transplant recipients not breastfeed, thus removing this concern.

    In summary, pregnancy is a wonderful experience in most transplant recipients as long as the above recommendations are observed. At California Pacific, we have experienced a multitude of successful pregnancies among our patients. We always look forward to meeting these new additions!

    About California Pacific Medical Center

    California Pacific Medical Center, part of the Sutter Health network, offers kidney, pancreas, liver and heart transplantation as part of our Barry S. Levin, MD Department of Transplant.

    Kidney & Pancreas Transplant Program
    California Pacific Medical Center
    2340 Clay Street
    San Francisco, CA 94115
    Tel. 415-600-1700

    Outreach locations available throughout Northern California and in Reno.