Twin pregnancy after renal transplant: the first case report in Thailand

Background: With more advanced technology, the renal transplant women have more chance to get pregnant, even multiple gestations. Obstetricians need the knowledge to provide the better care for these patients. Objective: Report the natural course of disease and the intervention for renal transplant woman with twin pregnancy. Patient and methods: A 20-year-old primigravida who underwent living-related renal transplantation eight months before pregnancy with monochrorionic diamniotic twins was treated throughout her pregnancy. Results: At 30 weeks of gestation, the patient was admitted due to rising of creatinine level, high blood pressure, and proteinuria. After conservative treatment for 12 days, the pregnancy was terminated by cesarean section with tubal resection. Both alive twins weighed 1385 g and 1525 g. Allograft kidney biopsy was undertaken, and histologic examination showed acute rejection. The renal function gradually improved after one month of antirejection therapy. Conclusion: The complications of pregnancy and poor perinatal outcomes are higher in renal transplant recipients. A multidisciplinary team is required for the management of these patients.