LAUSR

Preeclampsia (PE) and HELLP -syndrome often complicates pregnancies after maternal kidney transplantation. Moreover, women who become pregnant after renal transplantation are at higher risk of any TMA(thrombotic microangiopathy)-disorders. Objective We aimed to assess frequency of TMA, PE, HELLP –syndrome and negative obstetric outcomes, kidney function decline during the pregnancy. Methods An retrospective single-center cohort study 01/2014– 12/2017: 19 patients with renal allograft, 29  ±  4.35 years old (24–39). Renal function at conception and after delivery, pregnancy outcomes, clinical and laboratory parameters were collected from women who were pregnant after renal transplantation and had transplant and obstetric care. Results 10 of 19(52,6%) have had laboratory signs of TMA during pregnancy –gr.1. All of them had normal levels of calcineurin inhibitor concentration. Symptoms of TMA were wavy, alternating with spontaneous improvement and were not regarded as manifestations of a possible PE in 6 (sFlt-1 were normal). 4 of 19 (21.3%) had full HELLP-syndrome. Without TMA 9/19- gr.2. Only patients with HELLP or PE had elevated sFlt-1/PlGF ratio. There were no ”pure” PE(without signs of partial HELLP). In patients without signs of TMA, the sFlt-1 / PIGF ratio did not exceed the 4.95. Anemia was detected in all patients, but the signs of TMA showed anemia more pronounced. Thrombocytopenia was noted only in patients with signs of TMA. GFR was significantly reduced in all patients with signs of TMA. Conclusion Signs of TMA during pregnancy after kidney transplantation have had every second woman. Pregnancy outcomes were worse in TMA, newborns had lower Apgar scores, growth and birth weights. Pregnancy after kidney transplantation is independent risk factor of the development of HELLP syndrome, rather than ”pure” PE. Patients with TMA demonstrate the most pronounced impairment of kidney function and an unfavorable outcome of pregnancy.