Endocrine Abstracts

Introduction: Simultaneous pancreas-kidney transplantation (SPKT) is the best way to restore normoglycemia and renal function in patients with type 1 diabetes mellitus (T1D) and end-stage renal disease (ESRD). Pregnant patients after SPKT are a high-risk group for adverse events/loss fetal and transplantation organs. These risks are significantly reduced due to pregnancy planning, regular monitoring of the woman and fetus condition with timely correction of immunosuppressive therapy, maintaining blood pressure (BP) and glycemia, choosing the optimal birth time, mode of delivery.

Case Description: A 34-years-old woman with T1D (for 25 years) and ESRD underwent successful SPKT in 2021 in preparation for pregnancy. Graft function was preserved during treatment in endocrinology hospital in 2022: HbA1c=5.6%, estimated glomerular filtration rate 80.9 ml/min, normoalbuminuria. All necessary conditions for successful planned pregnancy outcome were discussed. A transplantologist adjusted immunosuppressive therapy: mycophenolic acid was replaced by azathioprine (teratogenic effect), the patient continued taking methylprednisolone and tacrolimus (his concentration was maintained within the target values). A 16-week pregnant patient was admitted to an endocrinologic hospital because of BP episodic elevating up to 160/90 mmHg in 2023. The transplanted kidney function corresponded to stage 3a microalbuminuric CKD. Blood glucose levels was found to be higher than the target values for pregnant women during diet therapy (HbA1c=5.6%, glycemia range: 4.6-9.3 mmol/l). Insulin (glargine) therapy was recommended due to failure to achieve the glycemic targets, which injections were refused by the patient. BP stabilized by optimal methyldopa dose selection. Glycemic target were ensured by diet therapy in the future. A 34-week pregnant patient was hospitalized in a nephrology ward because of increased creatinine level (175 μmol/l). After consultation with transplantologist it was decreased to 140 μmol/l due to reduction of the tacrolimus dose. A cesarean section was performed during the planned hospitalization to the maternity hospital at 38 weeks of pregnancy. The child birth weight was 3320 g, height - 52 cm, Apgar score 8-8 points. Creatinine, urea and blood glucose values of mother and child were normal in the postnatal period.

Conclusion: Pregnancy management in patients after SPKT should begin at the planning stage with the correction of immunosuppressive therapy and careful monitoring graft function. Such patients should be monitored by a multidisciplinary team (endocrinologist, nephrologist, obstetrician, transplantologist) in order to ensure a favorable pregnancy and delivery course with minimization of potential risks for mother and child. The success of these measures proves the experience of our patient.