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Kidney transplantation during a twin pregnancy. Case report and review of the literature

机译：双胎妊娠期间的肾脏移植。病例报告和文献复习

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摘要

Kidney transplant in a pregnant woman is exceptional, with only six cases being reported. Pregnancy was not known at the time of the transplant in five of these cases. We report the case of a 26-year-old woman who was diagnosed as carrying a twin pregnancy 4 months after starting hemodialysis. In order to improve the survival chances for the twins, she underwent an orthotopic renal transplant from a living donor at 20 weeks of gestation. The allograft functioned immediately and 4 weeks passed without incident. At the 26th week of gestation, the patient had a precipitous labor, delivering two male babies with no malformations, weighing 755 and 890 g, who died due to respiratory failure. The allograft worked normally afterwards. Sixteen months later, the patient delivered a normal 37 weeks’ gestation baby. The renal graft continued working normally for the next 20 years, after which signs of chronic allograft nephropathy developed. Azathioprine was replaced with mycophenolate mofetil. At the last evaluation, 23 years after transplant, the patient’s serum creatinine was 2.9 mg/dl and her estimated glomerular filtration rate (eGFR) was 22 ml/min/1.73 m2. This unique case demonstrates that it is possible to perform an orthotopic kidney transplant in a 20-week twin-gestation, with a long graft survival time.
机译：孕妇的肾脏移植是例外，仅报道了六例。其中有五例在移植时不知道怀孕情况。我们报告一例26岁的妇女，在开始血液透析4个月后被诊断为双胎妊娠。为了提高双胞胎的存活机会，她在妊娠20周时接受了来自活体供体的原位肾移植。同种异体移植立即起作用，并在4周内无意外发生。在妊娠的第26周，患者进行了剧烈的分娩，分娩了两个没有畸形的男婴，体重分别为755和890 g，他们因呼吸衰竭而死亡。同种异体移植后正常工作。 16个月后，患者分娩了正常的37周妊娠婴儿。肾移植物在接下来的20年中继续正常工作，此后出现了慢性同种异体肾病的迹象。硫唑嘌呤被霉酚酸酯代替。在移植后23年的最后一次评估中，患者的血清肌酐为2.9 mg / dl，估计的肾小球滤过率（eGFR）为22 ml / min / 1.73 m 2 。这个独特的案例表明，有可能在20周的双胎妊娠中进行原位肾移植，移植物存活时间长。

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