Three successful pregnancies after kidney transplantation with long-term graft survival: case report

Pregnancies after kidney transplantation are considered high risk. Preconceive care is crucial for favorable mother-fetal outcome but also for good renal graft function. Herein, we report a case of kidney transplant recipient secondary to lupus nephritis with three consecutive successful pregnancies and excellent graft function after 16 post-transplant years. Preconception care included two protocolar biopsies performed prior to immunosuppressive treatment modifications. No signs of rejections were found in either biopsy, no additional treatment was necessary, and the patient was safely converted from mycophenolate mofetil to azathioprine. First pregnancy was naturally conceived, its course was uncomplicated and a healthy female newborn wasdelivered via vaginal birth. Within one year after delivery the patient presented proteinuria, borderline changes were found in the biopsy of allograft and were treated with immunosuppression augmentation and ACEI.  At 7th post implantation year, after surveillance biopsy showing no signs of rejection and appropriate pharmacotherapy adjustments, second pregnancy occurred from in vitro fertilization (IVF). It was complicated with deep vein thrombosis, intrauterine growth restriction and premature birth in 32nd week of gestation. Three months after delivery, the patient conceived spontaneously, third pregnancy course was uncomplicated. Close follow up, including protocol and indication biopsies, allowed to preserve excellent graft function in the context of multiple immunosuppressive treatment adjustments. Here we present a case where natural conception and in vitro fertilization intertwine without harming the transplanted organ.