肾移植受者妊娠结局分析

Analysis of pregnancy outcome in renal transplant recipients

摘要

目的 探究异体肾移植受者妊娠的临床特征及母儿结局,为异体肾移植女性受者围产期管理提供理论依据。方法 回顾性纳入2005年1月至2022年12月于我院产科终止妊娠的11例异体肾移植受者作为研究对象,收集妊娠女性各项临床资料并进行随访,分析妊娠时机、妊娠期管理、终止妊娠时机、终止妊娠方式及母儿预后情况。结果 共纳入11例病例,平均妊娠年龄为(28.9±3.1)岁(24~33岁之间).妊娠与肾移植平均间隔时间为(68.8±9.0)个月(15~114个月).妊娠期主要并发症为尿蛋白(9/11,81.8%)、贫血(7/11,63.6%)、妊娠期高血压疾病(6/11,54.5%)、胎儿宫内生长受限(4/11,36.4%)及泌尿系感染(1/11,9.1%).其中1例患者因稽留流产引产,其余10例均行剖宫产终止妊娠.平均分娩孕周为(35.14±1.22)周(26.43~39.29周),新生儿平均出生体重为(2270.00±260.89)g(600g~3150g).新生儿主要的并发症包括:早产(7/9,77.8%)、低出生体重(4/9,44.4%)、脑室出血(3/9,33.3%)、房间隔缺损(2/9,22.2%)、坏死性结肠炎(1/9,11.1%)、贫血(1/9,11.1%).所有活产儿随访至今无明显生长发育异常。结论 同种异体肾移植受者妊娠系高危妊娠,母儿并发症多.选择合适的妊娠时机、给予产科、肾移植科及新生儿科等多学科协作管理,可获得良好的母儿结局.

Abstract

Objective To explore the clinical characteristics and maternal and fetal outcomes of pregnancy in allogeneic renal transplant recipients, and to provide a theoretical basis for perinatal management of female recipients of allogeneic renal transplantation. Methods Retrospective inclusion of 11 allogeneic kidney transplant recipients who terminated their pregnancies in our obstetrics department from January 2005 to December 2022 as study subjects. The clinical data of pregnant women were collected and followed up. The timing of pregnancy, management of pregnancy, timing of termination of pregnancy, mode of termination of pregnancy and prognosis of mother and child were analyzed. Results A total of 11 cases were included, with an average gestational age of (28.9±3.1) years (ranged from 24 to 33 years). The mean interval between pregnancy and kidney transplantation was (68.8±9.0) months (ranged from 15 to 114 months). The main complications during pregnancy were urinary protein (9/11, 81.8%), anemia (7/11, 63.6%), hypertensive disorder complicating pregnancy (6/11, 54.5%), intrauterine growth restriction (4/11, 36.4%) and urinary tract infection (1/11, 9.1%). One patient was induced due to missed abortion, while the remaining 10 cases underwent cesarean section to terminate pregnancy. The average gestational age during delivery is (35.14±1.22) weeks (ranged from 26.43 to 39.29 weeks). The average birth weight of the newborns was (2270.00±260.89) g (ranged from 600 g to 3150 g). The main neonatal complications included preterm birth (7/9, 77.8%), low birth weight (4/9, 44.4%), intraventricular hemorrhage (3/9, 33.3%), atrial septal defect (2/9, 22.2%), necrotizing enterocolitis (1/9, 11.1%), and anemia (1/9, 11.1%). Conclusion The pregnancy of allogeneic kidney transplant recipients is a high-risk pregnancy with multiple maternal and fetal complications. Choosing the appropriate timing of pregnancy and providing multidisciplinary collaborative management such as obstetrics, kidney transplantation, and neonatology can achieve good maternal and neonatal outcomes.

关键词

肾移植 / 妊娠并发症 / 分娩 / 妊娠结局

Key words

kidney transplantation / pregnancy complication / delivery / pregnancy outcome

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