REPRODUCTIVE OUTCOMES AND ASSOCIATED FACTORS AFTER KIDNEY TRANSPLANTATION IN ST. PAUL'S HOSPITAL MILLENNIUM MEDICAL COLLEGE

Abstract

Background: Women with end-stage renal disease have impaired fertility due to disruption of the hypothalamic gonadal axis. Pregnancy is therefore rare in women on dialysis with a very low incidence of conception ranging from 0.9 to 7%. Kidney transplantation regulates the chance of pregnancy, and some studies report an infertility rate similar to the general population rate (≈10%). No published and unpublished study has been found on the reproductive outcomes after kidney transplantation in Ethiopia. Therefore, a study on this topic is relevant, timely, and ultimately will provide suitable recommendations. Objectives: - To assess reproductive outcomes and associated factors in child bearing women who underwent kidney transplantation in SPHMMC and who underwent kidney transplantation abroad and have follow-up in SPHMMC. Methods: A facility-based 9-year retrospective descriptive study was conducted on women who underwent kidney transplantation in St Paul Hospital Millenium Medical College and who underwent kidney transplantation abroad that had follow-up in SPHMMC by reviewing their chart and interviewing with structured questionnaire. The inclusion criteria were Renal transplant recipients in the reproductive age group and the exclusion criteria were Renal transplant recipients who had preexisting reproductive disorders, who had previous fertility treatments and whose transplantation was less than 1 year. Results: This study evaluated 87 renal transplant recipients, of whom 52 (59.8%) experienced irregular menstruation prior to transplantation, with amenorrhea reported in 27 cases (51.9%) as the most common pattern. Post-transplant, 60 respondents (67.8%) resumed a regular menstrual cycle. Among the 87 participants, 58 (66.7%) had a history of infertility during ESRD, while others were unsure due to marital status or lack of sexual activity. The study documented 22 pregnancies in 15 renal transplant recipients, with an average age of 30.3 ± 6.2 years at first pregnancy and a mean interval of 3.6 years post-transplant. Of these pregnancies, 19 resulted in live births (10 term, 7 preterm), and 3 ended in spontaneous abortions. Additionally, 2 cases were classified as early neonatal death. Ten mothers experienced adverse obstetric outcomes, II including 7 (41.2%) preterm deliveries, 6 (35.2%) cases of chronic hypertension with superimposed preeclampsia, 2 (11.8%) cases of preeclampsia, and 2 (11.8%) cases of fetal growth restriction. Conclusion: Renal transplantation restores fertility in women but requires careful reproductive planning. Obstetricians and nephrologists should prioritize discussing menstrual and reproductive health with transplant recipients. Pregnancy after renal transplantation carries significant risks, including higher rates of maternal complications such as chronic hypertension, superimposed preeclampsia, and preeclampsia, as well as fetal complications like preterm delivery and growth restriction. Multidisciplinary care is essential to optimize outcomes for both mother and baby.