Pregnancy in a Kidney Transplant Recipient with Thrombophilia: A Case Report and Regional Literature Review

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.