Introduction: Simultaneous pancreas and kidney transplantation (SPK) is currently the best therapeutic option for patients with type 1 diabetes and terminal renal failure. Renal transplantation restores fertility enabling women to pursue pregnancies. However, scarcity of available data on pregnancy outcomes in SPK impedes fair medical counseling.
Methods: Between 1993 and 2015, the medical files of all pregnancies that lasted more than 3 months among recipients of successful SPK in France were retrospectively analyzed.
Results: Twenty-six pregnancies in 22 SPK recipients were identified. Main maternal complications included gestational hypertension (53.8%) and infections (50%). Caesarean section was performed in 73% of cases. Overall fetal survival was 92.6% with a mean gestational age of 34.2 ± 3 weeks. Eleven (40.7%) children presented intra-uterine growth retardation at 2^nd trimester ultrasound but birth weight < 10^th percentile was only observed in 4 cases (16.7%). Endocrine pancreas graft function remained stable during pregnancy. An acute kidney rejection occurred in 2 patients, one of which resulting in graft loss. Kidney and pancreas graft survival was respectively 90.7% and 100% at 1 year.
Conclusion: Pregnancy in SPK is feasible, but patients should be informed of the risks for the fetus, the mother and the grafts. Planning of pregnancy in SPK women is key to allow a personalized multidisciplinary monitoring, which represents the most straightforward approach to optimize outcomes.