신장이식 후 임신이 이식신 및 출산에 미치는 영향

Abstract

배경 : 신장이식후 임신은 증가하고 있는 추세이다. 많은 연구들이 신장이식 후 임신에서 이식신과 태아 및 산모 합병증의 위험성은 증가되나, 이식신에 대한 장기적인 결과에는 영향을 미치지 않는 것으로 보고하고 있다. 이에 본 연구는 신장이식 후 임신의 발생률과 이식신, 태아 및 산모 합병증 등에 대하여 고찰하였다.

대상 및 방법: 1990년 1월부터 2011년 12월까지 본원에서 신장이식을 시행받은 가임기 여성 (15~45세) 145명을 대상으로, 임신군(n=17, 임신 26예)과 대조군(n=128)으로 분류하여 임신의 결과와 이식신 기능 및 장기적인 이식신 생존율 등을 후향적으로 조사하였다.

결과 : 임신군과 대조군에서 신장이식 후 이식신 기능과 5년 및 10년 이식신 생존율은 차이가 없었다 (87.8%,74.8% vs 85.8%,70.2%, P>0.05). 임신의 결과는 정상분만 10예, 치료적 인공인신중절 8예, 자연유산 7예 및 임신유지 1예 이었다. 임신군에서 혈청 크레아티닌 수치는 임신 초기 (1.14±0.37 mg/dL)에 기준치 (1.23±0.37 mg/dL) 보다 내려 갔으며, 임신 후기(1.18±0.37 mg/dL) 에는 약간 증가되어 기준치로 돌아갔다. 신장이식 후 임신까지 평균 기간은 20.73±3.57 개월이었으며, 정상 분만율은 이식 후 임신까지의 기간이 길수록 유의하게 증가하였다 (71.78±37.75 vs 19.38±12.71 개월, p<0.001). 이식신 기능 및 이식신 생존율 등은 유의한 차이를 보이지 않았다.

결론 : 신장이식 후 임신은 이식신의 기능 및 장기 이식신 생존율에는 영향을 주지 않는 것으로 나타났으며, 신장이식 후 신기능이 안정적인 환자에서는 성공적인 임신 및 출산이 가능하다고 판단된다.|Background The number of pregnancies in renal transplant recipients has increased. Many studies show that pregnancy increases the risk of graft, fetal, and maternal complications but not affect the long-term outcomes of the graft. We assessed the incidence of pregnancy after renal transplantation and examined graft, fetal, and maternal outcomes.

Materials and methods Our study involved 145 women recipients of child-bearing age (15-45 years) in our center from January 1990 to December 2011. The women were divided into two groups : pregnancy group (n=17) and control group (n=128). The 26 pregnancies in the 17 recipients were categorized as live births (n=10) or no-live births (n=16). These were analyzed to evaluate pregnancy outcomes, graft function and long-term graft survival.

Results The pregnancy and control group had similar graft function and graft survival rates 5- and 10-years after renal transplantation. Outcomes of pregnancy were 10 live births, 8 therapeutic abortions, 7 spontaneous abortions, and 1 stillbirth. The mean serum creatinine levels of the pregnant recipients diminished during the first trimester (1.14±0.37 mg/dL) and increased slightly during the third trimester (1.18±0.37 mg/dL) to levels nearer the baseline (1.23±0.37 mg/dL). These ranges were stable. The mean time from transplantation to pregnancy was 20.73±3.57 months. Live birth rates were associated with the time from transplantation to pregnancy (71.78±37.75months for live births and 19.38±12.71months for no-live births, p<0.001). There were no significant differences in graft function, graft failure rates and survivals.

Conclusion Pregnancy does not appear to have an adverse effect on graft function and the long-term outcomes of renal transplantation. If recipients who want to become pregnant have a stable renal function, they can have successful pregnancies.; Background The number of pregnancies in renal transplant recipients has increased. Many studies show that pregnancy increases the risk of graft, fetal, and maternal complications but not affect the long-term outcomes of the graft. We assessed the incidence of pregnancy after renal transplantation and examined graft, fetal, and maternal outcomes.

Materials and methods Our study involved 145 women recipients of child-bearing age (15-45 years) in our center from January 1990 to December 2011. The women were divided into two groups : pregnancy group (n=17) and control group (n=128). The 26 pregnancies in the 17 recipients were categorized as live births (n=10) or no-live births (n=16). These were analyzed to evaluate pregnancy outcomes, graft function and long-term graft survival.

Results The pregnancy and control group had similar graft function and graft survival rates 5- and 10-years after renal transplantation. Outcomes of pregnancy were 10 live births, 8 therapeutic abortions, 7 spontaneous abortions, and 1 stillbirth. The mean serum creatinine levels of the pregnant recipients diminished during the first trimester (1.14±0.37 mg/dL) and increased slightly during the third trimester (1.18±0.37 mg/dL) to levels nearer the baseline (1.23±0.37 mg/dL). These ranges were stable. The mean time from transplantation to pregnancy was 20.73±3.57 months. Live birth rates were associated with the time from transplantation to pregnancy (71.78±37.75months for live births and 19.38±12.71months for no-live births, p<0.001). There were no significant differences in graft function, graft failure rates and survivals.

Conclusion Pregnancy does not appear to have an adverse effect on graft function and the long-term outcomes of renal transplantation. If recipients who want to become pregnant have a stable renal function, they can have successful pregnancies.