Kolkata, Feb 20: In a rare and highly complex medical achievement, a multidisciplinary team at Manipal Hospitals successfully managed an extremely high-risk pregnancy in a renal transplant recipient, ensuring the safety of both mother and child while preserving graft function.
The case was led by Dr. Upal Sengupta, Director – Team Nephrology & Consultant – Nephrology & Kidney Transplant, and Dr. Shilpita Banerjee, Consultant – Gynaecology, Obstetrics and Maternal Fetal Medicine, at Manipal Hospital Mukundapur.
The patient, 33-year-old Madhabilata Kundu from Burdwan, had undergone a kidney transplant in December 2023. She presented at the hospital at 16 weeks of pregnancy while on long-term immunosuppressive therapy. Her medical history included a previous caesarean section, a spontaneous miscarriage, hypertension and hypothyroidism — significantly elevating the risks associated with a post-transplant pregnancy.
Following extensive counselling and shared decision-making, the team opted to continue the pregnancy under strict multidisciplinary supervision involving specialists from Nephrology, Obstetrics, Anaesthesia, Critical Care and Neonatology.
Managing Multiple Critical Complications
At 21 weeks of gestation, the patient developed serious complications, including suspected graft dysfunction, severe anaemia, rising creatinine levels, uncontrolled hypertension and active infections. She required urgent hospitalisation, blood transfusions, modification of immunosuppressive therapy and aggressive infection management. Continuous fetal surveillance was conducted to ensure fetal well-being.
Despite stabilisation, by 28 weeks the patient exhibited worsening renal parameters, fluctuating blood pressure, intrauterine growth restriction and reduced amniotic fluid levels, raising serious concerns regarding maternal safety and graft preservation.
After detailed interdisciplinary consultations, the medical team decided to proceed with an early planned caesarean section at 30 weeks and three days of gestation in the best interest of the mother.
With strong anaesthetic and neonatal support, the patient delivered a 1.6 kg baby girl who cried immediately after birth and was shifted to the Neonatal Intensive Care Unit (NICU), where she received specialised care for 20 days.
Clinical Perspectives
Explaining the obstetric complexities, Dr. Shilpita Banerjee said:
“This pregnancy was medically fragile from the very beginning. The patient was battling multiple systemic complications, and even small clinical changes had the potential to significantly impact both maternal and fetal outcomes. Coordinated teamwork and vigilant surveillance allowed us to safely prolong the pregnancy despite repeated challenges.”
Sharing the nephrology perspective, Dr. Upal Sengupta added:
“Pregnancy following renal transplantation is inherently high-risk as it places additional physiological stress on the transplanted kidney. Our priority was to protect graft function while allowing the pregnancy to progress safely. This required continuous reassessment, careful adjustment of immunosuppressive therapy and avoidance of invasive procedures. The success of this case underscores the importance of timely decision-making and multidisciplinary coordination.”
Post-Delivery Recovery
Post-delivery, the mother experienced hypertension and a urinary infection and required ICU support for three days. With timely medical intervention, her condition stabilised and renal parameters improved. She has since been discharged in stable condition. The baby has also been discharged and is reported to be doing well.
Expressing her gratitude, Madhabilata Kundu said:
“There were moments when I feared losing my baby or harming my transplanted kidney. The doctors stood by me through every complication, explained every step and gave me confidence. Today, seeing my baby healthy feels nothing short of a miracle.”
Her husband, Tapas Kundu, supported her throughout the prolonged treatment and recovery process.
A Case That Offers Hope
This case highlights how early counselling, vigilant monitoring and seamless collaboration across specialties can make even the most high-risk post-transplant pregnancies successful, offering renewed hope to women with complex medical histories.