tation from a living related donor in Case 3: A 28-year-old woman had been undergoing hemodialysis since In June 1992, she received a kidn

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1 Successful pregnancy and delivery in a patient on maintenance hemodialysis and in two patients after kidney transplantation Nobuo Ishikawa, Osamu Yamaguchi, Mari Kimura, Norio Obata, Kazunori Sonda*, Kota Takahashi*, Hiroshi Toma*, Tetsuzo Agishi*, Kazuo Ota* Kidney Center, Tachikawa General Hospital; Kidney Center, Tokyo Women's Medical College* We report 3 cases of successful pregnancy and delivery in chronic renal failure patients. One patient had been undergoing chronic hemodialysis, the others were being followed after kidney transplantation. Case 1: A 31-year-old woman had been undergoing hemodialysis since In November 1987, she was found to have a pregnancy of 8 gestational weeks. She delivered a boy weighing 1,625g by the vaginal route at 31 gestational weeks. He suffered imperforate anus. Case 2: A 39-year-old woman had been undergoing hemodialysis since In August 1989, she received a kidney from her father. In August 1992, she was found to have a pregnancy of 7 gestational weeks. She delivered a boy weighing 2,275g by caesarean section at 38 gestational weeks. No congenital malformation was detected in the newborn. In this case, her husband had also been well controlled following kidney transplan

2 tation from a living related donor in Case 3: A 28-year-old woman had been undergoing hemodialysis since In June 1992, she received a kidney from her brother. In December 1993, she was found to have a pregnancy of 5 gestational weeks. She delivered a boy weighing 2,620g by caesarean section at 41 gestational weeks. No congenital malformation was detected in the newborn. In this case, the ciclosporin (CYA) concentrations in maternal and neonatal whole blood samples, breast milk and amniotic fluid were determined by radioimmunoassay (RIA). No side effects of CYA were observed in this baby. CYA, however, was present in maternal breast milk, suggesting that breast feeding by CYA-treated mothers should be avoided.

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6 Criteria for consideration of pregnancy in renal transplant recipients

7 1) Murray JE, Duncan ER, Harrison JH, Merrill JP: Successful pregnancies after human renal transplantation. N Engl J Med 269: , ) Confortini RM, Galanti G, Ancona G, Giongo A, Bruschi E, Lorenzini E: Full term preg nancy and successful delivery in a patient on chronic haemodialysis. Proc Eur Dial Trans plant Assoc 8: 74-80, ) Hou S, Grossman SD: Pregnancy in chronic dialysis patients. Seminar Dial 3: , ) Steegers EAP, Vav Lakwijk HPJ, Fast JH, Godschalx AWH, Jongsma HW, Eskes TKAB, Symonds EM, Hemn PR: Atrial natriuretic peptide and atrial size during normal pregnancy, Br J Obstet Gynecol 98 : , 1991

8 -592, ) Rizzoni G, Ehrich JHH, Broyer M, Brunner FP, Brynger H, Fassbinder W, Geerlings W, Selwood NH, Tufveson G, Wing AJ: Suc cessful pregnancies in women on renal replacement therapy: Report from the EDTA Registry. Nephrol Dial Transplant , ) Davison JM: Renal transplantation and pregnancy. Am J Kidney Dis 9: , ) Saarikoski S, Seppala M: Immunosuppres sion during pregnancy: Transmission of azathioprine and its metabolites from the mother to fetus. Am J Obstet Gynecol 115: , ) Flechner SM, Katz AR, Rogers AJ, Van Buren C, Kahan BD: The presence of cyclosporine in body tissues and fluids during pregnancy. Am J Kidney Dis 5: 60-63, ) Lewis GJ, Lamont CAR: Successful preg nancy in a renal transplant recipient taking cyclosporin A. Br Med J 286: 603, 1983

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