Key result
Switching MMF to azathioprine with anticoagulation results in zero thrombotic events during transplant pregnancy.
Why the study?
Pregnancy in kidney transplant recipients is a high-risk condition, and the presence of thrombophilia such as factor V Leiden mutation adds complexity due to increased thromboembolic risk and potential adverse effects on graft function.
Case Report (n=1)
Successful pregnancy without thrombotic events is achievable in high-risk kidney transplant recipients with factor V Leiden thrombophilia and prior vena cava thrombosis through preconception immunosuppression adjustment and multidisciplinary anticoagulation management.
Highlights complexities of managing thrombophilic pregnancies post-transplant; leaves open optimal anticoagulation protocols for prospective evaluation.
Background: Pregnancy in kidney transplant recipients is a high-risk condition requiring multidisciplinary management. The presence of thrombophilia, such as factor V Leiden mutation, adds a further layer of complexity due to the increased risk of thromboembolic events and potential adverse effects on graft function. Case Presentation: We report the case of a 29-year-old female kidney transplant recipient with a history of bilateral cortical necrosis following a previous pregnancy. She underwent kidney transplantation in December 2018 from a living-related donor (her aunt, HLA semi-identical). Pre- transplant workup revealed multiple catheter and arteriovenous fistula thromboses, and thrombophilia screening identified a factor V Leiden deficiency. She experienced thrombosis of the superior and inferior vena cava at seven months post-transplant, requiring anticoagulation with anti- vitamin K anticoagulant (acenocoumarol). Two years later, a desired pregnancy was planned with stable graft function, and immunosuppression was switched from mycophenolate mofetil (MMF) to azathioprine. Anticoagulation was maintained with strict multidisciplinary monitoring. No thrombotic events occurred during the pregnancy. Conclusion: Pregnancy in kidney transplant recipients with thrombophilia requires careful preconception planning, immunosuppression adjustment, and individualized anticoagulation. A multidisciplinary approach involving nephrologists, gynecologists, and hematologists is essential to optimize maternal and fetal outcomes while preserving graft function.
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Souad Chelghoum (2026) conducted a case report in Pregnancy in a kidney transplant recipient with Factor V Leiden thrombophilia (n=1). Immunosuppression switch (mycophenolate mofetil to azathioprine) and maintained anticoagulation was evaluated on Thrombotic events during pregnancy. Switching mycophenolate mofetil to azathioprine while maintaining anticoagulation resulted in 0 thrombotic events during pregnancy in a 29-year-old kidney transplant recipient with thrombophilia.
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