Mycobacterium Tuberculosis Infection Following Kidney Transplantation

Karima Boubaker^1, , Ezzedine Abderrahim¹, Taieb Ben Abdallah¹ and Adel Kheder¹

¹Research Laboratory of Immunology, Internal Medecine Department, Charles Nicole Hospital, Tunis

Cite this paper:
Karima Boubaker, Ezzedine Abderrahim, Taieb Ben Abdallah and Adel Kheder. Mycobacterium Tuberculosis Infection Following Kidney Transplantation. American Journal of Infectious Diseases and Microbiology. 2013; 1(4):79-83. doi: 10.12691/ajidm-1-4-5

Abstract

Fertility is considerably affected in chronic renal insufficiency and periodic hemodialysis and is improved by renal transplantation. Transplanted patients recover from their renal failure state and, pregnancy occurred in 2% in renal graft recipients in age to procreate. The aim of our study is to bring back the cases of pregnancies carried out in our renal patients transplanted and to specify the possible complications of the foetus and the mother schools to the course or after the childbirth. It is a retrospective study over one 20 years period of 1986 to 2006 of 10 pregnancies occurred in 7 renal transplant recipients followed in our Charles Nicole hospital department. Mean patient age was 33,8 years (29- 43 years). Mean time between transplantation and the onset of pregnancy was 6.5 years (1-18 years). Before pregnancy, hypertension was observed in 1 case and proteinuria in other case. All our patients had creatininemia<1,50mg /dl. Immunosuppressive treatment associated steroids and azathioprin in 3 cases, steroids and ciclosporin A in 2 cases and steroids, ciclosporin A and azathioprin in 2 cases. One patient developed diabetes. Maternal complications were rare, essentially hypertension in 2 cases, proteinuria in 1 case, ascension of creatininemia in 2 cases and hepatic cholestase in 2 cases. Deliverance was at time in 8 cases. Prematurity was observed in 2 cases; it was related to premature rupture of membranous in 1 case and uterine contractions in cesarean patient in other case. The mean neonatal weight was 2950 g (2100- 3500 g) with 4 small for gestational age (< 2800 g). It was noted 1 case of newborn down's syndrome in a pregnant women aged of 37 years. After a mean follow up of 7,4 years follow-up, mean cretininemia was 1,80mg /dl (0,74-5,53mg /dl). One patient showed chronic rejection. Immunosuppressive treatment seemed without adverse effects on fetus. The only case of chromosome abnormality was appeared in a pregnant women aged more than 35 years. The course of pregnancy after renal transplantation is generally uncomplicated without increased risk of graft loses. However, a normal arterial pressure, a stable renal function and absence of proteinuria are requested before allowing a pregnancy.

Keywords:
renal transplantation-pregnancy

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References:

[1]	Fuchs KM, Wa D, Ebcioglu Z. Pregnancy in renal transplant recipients. Semin Perinatol 2007;31:339.
[2]	Audra P et Laville M. Grossesse après greffe de rein. Encycl Med Chir, (Elsevier, Paris), Gynécologie/Obstétrique, 5-016-B-22, 1996, 4p.
[3]	Ville Y, Fernandez H, Edouard D, Frydman R. La grossesse après transplantation rénale. À propos de 27 patientes et revue de la littérature. J Gynecol Obstet Biol Reprod, 1992 ; 21 : 683-9.
[4]	Mc Kay DB, Josephson MA. Pregnancy in recipients of solid organs-effects on mother and child. N Eng J Med; 2006;354: 1281.
[5]	First MR, Combs CA, Weiskittel P, Miodovnik M. Lack of effect of pregnancy on renal allograft survival or function. Transplantation, 1995; 59: 472-6.
[6]	Davison JM. Dialysis, transplantation, and pregnancy. Am J Kidney Dis, 1991; 17: 127-32.
[7]	Ben Youssef R, Iwaki Y, Baron P et al. Successful living related kidney transplantation across an anti-donor HLA antibody. Transplant Proc 2006;38-1280.
[8]	O” Bas aran, Emirog R, Scc S et al. Pregnancy and renal transplantation. Transplant Proc 2004 ;36 :122.
[9]	Coscia LA, Constantinesca S, Moritz MJ et al. Report from the National Transplantation Pregnancy registry (NTPR) : outcomes of pregnancy after transplantation. National Transplantation Pregnancy Registry. Clin Transpl 2007;29,Review.
[10]	Sibanda N, Briggs JD, Davison JM et al. Outcomes of pregnancy after renal transplantation : a case report of UK Transplant Pregnancy Registry. Hypertens Pregnancy 2004;23:136.
[11]	Levidiotis V, Chang S, McDonald S. Pregnancy and maternal outcomes among kidney transplant recipients. J Am Soc Nephrol.2009;20:2433-40.
[12]	Nicovani V et al. Successful multiple pregnancy (triplets) in a kidney transplant recipient: a case report. Transplant Proc 2009;41:2688-90.
[13]	Davison JM. Towards long-term graft survival in renal transplantation: pregnancy. Nephrol Dial Transplant, 1995; 10 (suppl 1): 85-9.
[14]	Fitoussi A, Lefebvre G, Frantz P, Luciani J, Camus M, Clough K, et al. Analyse de 10 cas de grossesse après transplantation rénale. J Gynecol Obstet Biol Reprod, 1990 ; 19 : 69-76.
[15]	Ross FL. Ethical considerations related to pregnancy in transplant recipients. N Eng J Med 2006;354:1313.
[16]	Rizzoni G, Ehrich JHH, Broyer M, Brunner FP, Brynger H, Fassbinder W, et al. Successful pregnancies in women on renal replacement therapy: report from the EDTA registry. Nephrol Dial Transplant, 1992; 7: 279-87.
[17]	Armenti VT, Ahlswede KM, Ahlswede BA, Cater JR, Jarrell BE, Mortiz MJ, et al. Variables affecting birthweight and graft survival in 197 pregnancies in cyclosporine-treated female kidney transplant recipients. Transplantation, 1995; 59: 476-9.
[18]	Armenti VT, Constantinescu S, Moritz MJ, Davison JM. Transplantation Reviews 2008;22:223-40.
[19]	Framarino dei Malatesta M, Rossi M, Rocca B et al. Fertility following solid organ transplantation. Transplan Proc 2007;39:2001-4.
[20]	Armenti VT, Ahlswede KM, Ahlswede BA, Cater JR, Moritz MJ, Burke JF. National transplantation pregnancy registry: analysis of outcome/risks of 394 pregnancies in kidney transplant recipients. Transplant Proceedings, 1994; 26: 2535.
[21]	Muirhead N, Sabharwal AR, Rieder MJ, Lazarovits AI, Hollomby DJ. The outcome of pregnancy following renal transplantation. The experience of a single center. Transplantation, 1992; 54: 429-32.
[22]	Davison JM, Lind T, Uldall P. Planned pregnancy in a renal transplant recipient. Br J Obstet Gynaecol, 1976; 83: 518-27.
[23]	Blowey DL, Warady BA. Outcome of infants born to women with chronic kidney disease. Adv Chronic Kidney Dis 2007;144:199-205.
[24]	Rudolph J, Schweizer R, Bartus S. Pregnancy in renal transplant patients. Transplantation, 1979; 27: 26-9.
[25]	Hibbard JU. Obstetric considerations in the management of pregnancy in kidney transplant recipients. Adv Chronic Kidney Dis. 2007;14:168-77.
[26]	Framarino di Malatétaita ML, Poli L, Pierucci F, Paolucci A, Pretagostini R, Di Nicuolo A, et al. Pregnancy and kidney transplantation: clinical problems and experience. Transplant Proceedings, 1993; 25: 2188-9.
[27]	Nojima M, Ihara H, Ichikawa Y, Fujimoto N, Fukunishi T, Arima M, et al. Influence of pregnancy on graft function after renal transplantation. Transplant Proc, 1996; 28: 1582-5.
[28]	Haugen G, Fauchald P, Sodal G, Leivétaitad T, Moe N. Pregnancy outcome in renal allograft recipients in Norway. The importance of immunosuppressive drug regimen and health status before pregnancy. Acta Obstet Gynecol Scand, 1994; 73: 541-6.
[29]	Pickrell MD, Sawers R, Michael J. Pregnancy after renal transplantation: severe intrauterine growth retardation during treatment with cyclosporin A. Br Med J, 1988; 296: 825.
[30]	Williams P, Brons I, Evans D, Robinson R, Calne R. Pregnancy after renal transplantation. Br Med J, 1988; 296: 1400.
[31]	Anderka MT, Lin AE, Abuelo DN, Mitchell AA, Rasmussen SA. Reviewing the evidence for mycophenolate mofetil as a new teratogen: case report and review of the literature. Am J Med Genet A. 2009;149:1241-8.
[32]	Dei Malatétaita MF, Rocca B, Gentile T, Hadjistilianou T, Borri M, de Francesco S, Pisani F, Famulari A. A case of coloboma in a newborn to a woman taking mycophenolate mofetil in pregnancy after kidney transplantation.Transplant Proc. 2009;41:1407-9.
[33]	Bererhi L, Bedrossian J, Metivier F, Duboust A, Fornairon S, Marrast AC, et al. Pregnancy in kidney transplantation: past and present experience. Transplant Proc, 1997; 29: 2478.
[34]	Carosella ED. HLA-G: from feto-maternal tolerance to organ grafting Bull Mem Acad R Med Belg. 2009;164(3-4):87-99; discussion 99-101.
[35]	Rahman TM, Wendon J. Severe hepatic dysfunction in pregnancy. QJ Med 2002;95:343-57.
[36]	Pereira SP, O’Donohue J, Wendon J, William R. Maternal and perinatal outcome in severe pregnancy – related liver disease. Hepatology 1997;26:1258-62.
[37]	Bouattar T, Hakim H, Rhou H, Benamar L, Bayahia R, Ouzeddoun N. Pregnancy in renal transplant recipients. Transplant Proc 2009;41:1586-8.
[38]	Caplan RM, Dosetor JB, Maughan GB. Pregnancy following cadaver kidney homotransplantations. Am J Obstet Gynecol 1970;106:644.
[39]	Chaouat G, Szekeres –Bartho J, Menu E and al. Immunologie de la relation materno-foetale. Med Sci 1989 :20-26.
[40]	Hamid AH. Pregnancy in renal transplant recipients : a review. Obstet Gynecol Suurv 1986; 41: 264-71.
[41]	Gutiarrez MJ et al. Renal allograft function and cardiovascular risk in recipients of kidney transplantation after successful pregnancy.Transplant Proc 2009;41:2399-402.
[42]	Penn I, Makowski EL, Harris P. Parenthood following renal and hepatic transplantation. Transplantation, 1980; 30: 397-400.
[43]	Tanabe K, Kobayashi C, Takahashi K, Sonda K, Kawai T, Fuchinove S, et al. Long term renal function after pregnancy in renal transplant recipients. Transplant Proc, 1997; 29: 1567-8.
[44]	Moritz MJ. Pregnancy outcomes in female renal transplant recipients. NDT 2002;24:55.
[45]	Cornella C, Riboni F, Pratico L et al. Pregn,ancy and renal transplantation : A case report of the risk of antibody induction against partner antigens. Transpl Proc 2009;41:3964-6.
[46]	Thompson BC, Kingdon EJ, Tuck SM et al. Pregnancy in renal transplant recipients: the Royal Free Hospital experience. QMJ 2003;96:837.