1
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Coscia LA, Kliniewski D, Constantinescu S, Moritz MJ. Pregnancy after transplant in the older adolescent: Anticipatory guidance for the pediatric provider. Pediatr Transplant 2024; 28:e14752. [PMID: 38682682 DOI: 10.1111/petr.14752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 03/21/2024] [Accepted: 03/25/2024] [Indexed: 05/01/2024]
Abstract
BACKGROUND Healthcare providers who care for adolescent and young adult transplant recipients should be aware of contraception counseling and potential for pregnancy in this at-risk cohort. METHODS This paper will review contraceptive options in general for transplant recipients. There will also be a review of common immunosuppressive medications and their risk profile regarding pregnancy after transplantation. Data from the Transplant Pregnancy Registry International were analyzed looking at recipients conceiving under the age of 21 and were compared to overall pregnancy outcomes. RESULTS Overall pregnancy outcomes in recipients under the age of 21 are like the adult cohort. CONCLUSION It is imperative to provide contraception counseling to the adolescent and young adult and inform their caregiver that pregnancy can happen if the recipient is sexually active. Pregnant adolescent and young adult transplant recipients should be followed by a multidisciplinary team to assure a positive outcome for the recipient, transplant, and neonate.
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Affiliation(s)
- Lisa A Coscia
- Transplant Pregnancy Registry International, a division of Gift of Life Institute, Philadelphia, Pennsylvania, USA
| | - Dorothy Kliniewski
- Transplant Pregnancy Registry International, a division of Gift of Life Institute, Philadelphia, Pennsylvania, USA
| | - Serban Constantinescu
- Transplant Pregnancy Registry International, a division of Gift of Life Institute, Philadelphia, Pennsylvania, USA
- Department of Medicine, Section of Nephrology, Hypertension and Kidney Transplantation, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
| | - Michael J Moritz
- Transplant Pregnancy Registry International, a division of Gift of Life Institute, Philadelphia, Pennsylvania, USA
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2
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Szpotanska-Sikorska M, Knap-Wielgus W, Jasak K, Ajdacka-Matczuk U, Stelmach D, Korzeb B, Jabiry-Zieniewicz Z. Family Planning and Assessment of the Frequency of Exposure to Drugs Contraindicated in Pregnancies After Kidney or Liver Transplantation: A Retrospective Cross-Sectional Study. Transplant Proc 2024; 56:912-915. [PMID: 38735765 DOI: 10.1016/j.transproceed.2024.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Revised: 03/25/2024] [Accepted: 03/26/2024] [Indexed: 05/14/2024]
Abstract
BACKGROUND A successful organ transplant restores gonadal function in the first months after surgery, which leads to the normalization of menstrual cycles and increases the chance of pregnancy. Recipients of organ transplants should effectively prevent pregnancy for a minimum of 1 year and optimally up to 2 years after surgery. This study aimed to evaluate the incidence of unplanned pregnancies in female organ transplant recipients METHODS: A cross-sectional, single-center survey study of 46 pregnant organ recipients who were hospitalized at the Department of Obstetrics and Gynaecology. RESULTS In the post-transplant period, we recorded 46 patients, including 27 kidney recipients (59%) and 19 liver recipients (41%). Forty-nine respondents reported 66 pregnancies, of which 52 ended in live births (79%). Twenty of the pregnancies were not planned. In that group, 16 pregnancies ended in labor, 2 in miscarriage, and 2 in termination. In 10 of the unplanned pregnancies, the women were treated with potentially teratogenic drugs in the first trimester. The duration of the pregnancy was shorter in the group of women who had not planned their pregnancies and had conceived during potentially teratogenic therapy (30.66 ± 3.61 weeks) than in women who had planned their pregnancies (34.95 ± 4 weeks, P < .0215). CONCLUSION Women after organ transplantation are at high risk for pregnancy complications. Therefore, conception planning is an important element of post-transplant care, especially because the percentage of unplanned pregnancies in this group remains high despite the use of potentially teratogenic drugs.
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Affiliation(s)
| | | | - Kamil Jasak
- 1st Department of Obstetrics and Gynecology, Medical University of Warsaw, Poland
| | | | - Daria Stelmach
- 1st Department of Obstetrics and Gynecology, Medical University of Warsaw, Poland
| | - Bartosz Korzeb
- 1st Department of Obstetrics and Gynecology, Medical University of Warsaw, Poland
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3
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Corr M, McKeaveney C, Wurm F, Courtney A, Noble H. Patient education interventions for adolescent and young adult kidney transplant recipients- a scoping review. PLoS One 2023; 18:e0288807. [PMID: 37459325 PMCID: PMC10351733 DOI: 10.1371/journal.pone.0288807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 06/29/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND Adolescence and young adulthood are high risk periods for kidney transplant recipients. The reasons for this are complex; but are predominantly thought to be due to poor adherence to immunosuppressive medications. Patient education can help support young recipients to reduce their risk of behaviour-related transplant loss. The aim of this review was to understand what is known about education interventions targeted at adolescent and young adult kidney transplant recipients. METHODS Systematic scoping review methodology was utilised. Six online databases were searched for suitable articles. Articles were selected for full text review following title and abstract screening. Articles deemed eligible to be included in the review had data extracted, which were qualitatively analysed using thematic analysis. Findings were validated through a consultation exercise with both young recipients and healthcare professionals. RESULTS 29 studies were eligible for inclusion in the review. There was a high level of heterogeneity in the content, mode, design, and measurement of efficacy of interventions in the selected studies. Traditional face-to-face education and transition clinics were the most common educational interventions. Using technology to enhance patient education was also a major theme identified. Few studies reported using educational theory or involving patients in intervention design. DISCUSSION Four key research gaps were identified. 1.) Lack of educational theory in intervention design 2.) Lack of patient/ stakeholder involvement 3.) Identifying best way to measure efficacy 4.) identifying novel future research questions within already well established paediatric and educational frameworks. Addressing these gaps in future research will help inform best-practice in this vulnerable population.
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Affiliation(s)
- Michael Corr
- School of Medicine- Queen’s University Belfast, Belfast, Northern Ireland
| | - Clare McKeaveney
- School of Nusring- Queen’s University Belfast, Belfast, Northern Ireland
| | - Fina Wurm
- School of Nusring- Queen’s University Belfast, Belfast, Northern Ireland
| | - Aisling Courtney
- Regional Nephrology & Transplant Unit-Belfast Health and Social Care Trust, Belfast, Northern Ireland
| | - Helen Noble
- School of Nusring- Queen’s University Belfast, Belfast, Northern Ireland
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4
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Singer P. Post-transplant education for kidney recipients and their caregivers. Pediatr Nephrol 2022:10.1007/s00467-022-05744-6. [PMID: 36227432 DOI: 10.1007/s00467-022-05744-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 08/31/2022] [Accepted: 09/06/2022] [Indexed: 11/29/2022]
Abstract
Successful outcomes in pediatric kidney transplantation require the involvement of the transplant team as well as recipients and their caregivers. Enhancing patient and family understanding of the disease and of post-transplant care can result in improved adherence and outcomes. Educational strategies should aim to be broad, understandable, innovative, and inclusive while maintaining a tailored approach to individualized care. Teaching should not be viewed as a one-time event but rather as an ongoing conversation throughout the duration of care, emphasizing different aspects throughout the patient's various developmental stages. The following review article discusses the content and methods of post-transplant education.
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Affiliation(s)
- Pamela Singer
- Department of Pediatrics, Cohen Children's Medical Center-Long Island Jewish Medical Center, 269-01 76th Ave, New Hyde Park, NY, 11040, USA.
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5
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Abstract
Placed in a historical context, this overview focuses on post-transpant pregnancy, fatherhood, and contraception in women and men. The critical importance of early reproductive counseling because of improved sexual function and the early return of ovulation and menses post-transplant is emphasized. We explain the decision making regarding contraception choices. The available data on the safety of immunosuppressive drugs in pregnancy, and for men desiring fatherhood, are detailed. The risk of maternal ingestion of mycophenolate products on the in utero fetus is considered and contrasted with the lack of concern for their use by men fathering children. Pregnancy risks to the allograft, baby, and mother are discussed. An infant's exposure to specific immunosuppressant medications through breastfeeding is reviewed. The ethics and realities of post-transplant parenthood are explored.
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Affiliation(s)
- Christina L. Klein
- Piedmont Transplant Institute, Piedmont Healthcare Inc., Atlanta, Georgia
| | - Michelle A. Josephson
- Section of Nephrology, Division of Biological Sciences, University of Chicago, Chicago, Illinois
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6
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Ardura MI, Coscia LA, Meyers MR. Promoting safe sexual practices and sexual health maintenance in pediatric and young adult solid organ transplant recipients. Pediatr Transplant 2021; 25:e13949. [PMID: 33491268 DOI: 10.1111/petr.13949] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 12/01/2020] [Accepted: 12/02/2020] [Indexed: 12/17/2022]
Abstract
The majority of Americans make their sexual debut during their adolescent years. Preventing pregnancy and STI during this period is vital to ensuring health and safety. As survival has improved after pediatric SOT, chronically immunosuppressed adolescents seek guidance in their medical home on matters of sexual health. Transplant practitioners often do not feel equipped to fully address these needs. This review serves as an introductory sexual preventive care resource for adolescent and young adult (AYA) SOT recipients. First, we review data on safety, efficacy, and use of contraceptive options currently available for transplant recipients with child-bearing potential. Then, we suggest a personalized sexual health discussion focusing on the diagnosis and prevention of STIs in adolescent and young adult transplant recipients. Finally, we present recommendations for STI screening of asymptomatic patients, use of index of suspicion and diagnostic testing in symptomatic patients, and opportunities to optimize STI prevention strategies. Data compiled from studies of adult SOT recipients, general population studies, and published guidelines are often extrapolated for use, as limited data exist in AYA SOT recipients. This informational dearth underscores the need for future research to better characterize the unique needs of AYA SOT recipients.
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Affiliation(s)
- Monica I Ardura
- Pediatric Infectious Diseases & Host Defense, Nationwide Children's Hospital, The Ohio State University, Columbus, OH, USA
| | - Lisa A Coscia
- Transplant Pregnancy Registry International, Philadelphia, PA, USA
| | - Melissa R Meyers
- Pediatric Nephrology, Children's National Health System, Washington, DC, USA
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7
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Ziogas IA, Hayat MH, Tsoulfas G. Obstetrical and gynecologic challenges in the liver transplant patient. World J Transplant 2020; 10:320-329. [PMID: 33312893 PMCID: PMC7708880 DOI: 10.5500/wjt.v10.i11.320] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 10/05/2020] [Accepted: 10/20/2020] [Indexed: 02/06/2023] Open
Abstract
An increasing number of childbearing agewomen undergo liver transplantation (LT) in the United States. Transplantation in this patient subgroup poses a significant challenge regarding the plans for future fertility, particularly in terms of immunosuppression and optimal timing of conception. Intrapartum LT is only rarely performed as the outcome is commonly dismal for the mother or more commonly the fetus. On the other hand, the outcomes of pregnancy in LT recipients are favorable, and children born to LT recipients are relatively healthy. Counseling on pregnancy should start before LT and continue after LT up until pregnancy, while all pregnant LT recipients must be managed by amultidisciplinary team, including both an obstetrician and a transplant hepatologist. Additionally, an interval of at least 1-2 years after successful LT is recommended before considering pregnancy. Pregnancy-induced hypertension, pre-eclampsia, and gestational diabetes mellitus are reported more commonly during the pregnancies of LT recipients than in the pregnancies of non-transplant patients. As adverse fetal outcomes, such asmiscarriage, abortion, stillbirth, or ectopic pregnancy, may occur more often than in the non-transplant population, early planning or delivery either through a planned induction of labor or cesarean section is critical to minimize the risk of complications. No significant long-term physical or phycological abnormalities have been reported in children born to LT recipients.
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Affiliation(s)
- Ioannis A Ziogas
- Medical School, Aristotle University of Thessaloniki, Thessaloniki 54124, Greece
| | - Muhammad H Hayat
- Department of Medicine, Division of Gastroenterology, Hepatology and Nutrition, Vanderbilt University Medical Center, Nashville, TN 37212, United States
| | - Georgios Tsoulfas
- Department of Surgery, Papageorgiou University Hospital, Aristotle University of Thessaloniki, Thessaloniki 54622, Greece
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8
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Davis-Kankanamge C, Higgins J, Allsworth JE, Strickland J. Menstruation and contraception patterns of female adolescent transplant recipients. Pediatr Transplant 2020; 24:e13817. [PMID: 32808738 DOI: 10.1111/petr.13817] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 07/13/2020] [Accepted: 07/15/2020] [Indexed: 01/22/2023]
Abstract
BACKGROUND There is a lack of knowledge regarding menstrual cycles and contraception usage for adolescent transplant patients and families. Solid organ transplant patients start teratogenic medications which have pregnancy implications. We explore adolescent female solid organ transplant recipient and guardian's contraceptive knowledge and attitudes as well as menstrual patterns. METHODS A cross-sectional descriptive research design was utilized to collect information from adolescent female transplant patients who are on mycophenolate mofetil after solid organ transplant and their guardians within our freestanding children's hospital via a survey. The sample consisted of all female adolescent patients who have completed a solid organ transplant and are on mycophenolate mofetil from April 2016 through May 2017. RESULTS Twenty-one patients were approached, of which nineteen patients and seventeen guardians completed the survey. The average age of the patient was 16.2 years. The average age at time of transplant was 12.2 years. The type of transplants includes renal (57.1%), heart (23.8%), and liver (4.8%). There were six patients (33.3%) who had a history of sexual activity; among these patients, the mean number of partners in the last year was 1.2. Menstrual concerns included dysmenorrhea, irregular bleeding, and heavy bleeding pre- and post-transplant, respectively. Participants reported contraceptive counseling prior to and after transplant approximately half of the time. CONCLUSIONS Adolescent solid organ transplant patients have multiple reproductive needs including contraception, dysmenorrhea, and irregular bleeding. Integration of contraceptive knowledge into clinical care received by adolescents with solid organ transplants is supported by knowledge gained through this study.
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Affiliation(s)
| | - Jeanette Higgins
- Department of Surgery, Children's Mercy Hospital, Kansas City, MO, USA
| | - Jenifer E Allsworth
- Department of Biomedical and Health Informatics, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - Julie Strickland
- Department of Surgery, Children's Mercy Hospital, Kansas City, MO, USA
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9
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Sohail R, Bashir A, Safdar Z, Noreen A. Successful pregnancy in a liver transplant patient of Budd-Chiari syndrome. BMJ Case Rep 2020; 13:13/2/e229315. [PMID: 32041753 DOI: 10.1136/bcr-2019-229315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
In recent years, the number of patients undergoing liver transplant has increased. Successful transplant has resulted in better quality of life and improved fertility in younger women. This is a case study a 31-year-old woman, who had history of Budd-Chiari syndrome and underwent liver transplantation in 2014 with uneventful postoperative course. She was clinically stable on tablet tacrolimus and coumarin with no episode of allograft rejection since transplantation. The patient conceived spontaneously, after 4 years of transplant and during pregnancy, she was managed by multidisciplinary team. During the initial period, the graft and pregnancy continued without complications. However, at 33 weeks, the patient presented with sluggish fetal movements, amniotic fluid index of 3.4 and SD ratio of 3.31 for which she underwent caesarean section. She delivered a healthy female baby of 1.4 kg. This case study concludes that vigilant monitoring of fetal growth is pivotal for optimal fetal outcome.
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Affiliation(s)
- Rubina Sohail
- Obstetrics & Gyunaecology, Services Institute of Medical Sciences, Lahore, Punjab, Pakistan .,Obstetrics & Gynaecology, Hameed Latif Hospital, Lahore, Punjab, Pakistan
| | - Alia Bashir
- Obstetrics & Gynaecology, Hameed Latif Hospital, Lahore, Punjab, Pakistan
| | - Zara Safdar
- Obstetrics & Gynaecology, Hameed Latif Hospital, Lahore, Punjab, Pakistan
| | - Asifa Noreen
- Obstetrics & Gynaecology, Services Hospital, Lahore, Punjab, Pakistan
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10
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Sawas T, Simonetto DA. Should Pregnancy After Liver Transplantation Bring Joy or Fear? Clin Gastroenterol Hepatol 2019; 17:1251-1252. [PMID: 30802605 DOI: 10.1016/j.cgh.2019.02.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 02/08/2019] [Accepted: 02/17/2019] [Indexed: 02/07/2023]
Affiliation(s)
- Tarek Sawas
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
| | - Douglas A Simonetto
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
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11
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Szpotanska-Sikorska M, Mazanowska N, Kociszewska-Najman B, Wielgos M, Pietrzak B. Unintended pregnancies and family planning among women after kidney or liver transplantation. J Matern Fetal Neonatal Med 2018; 33:1346-1352. [PMID: 30251568 DOI: 10.1080/14767058.2018.1518420] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Background: To evaluate the incidence of unplanned pregnancies in female organ transplant recipients.Methods: In a single-center cross-sectional study 252 women aged 18-45 years who underwent kidney or liver transplantation were asked to fill in a survey form.Results: 217 (86%) women were enrolled in the study. Fifty-three percent of women declared 181 pregnancies, of which 30% (54/181) were unplanned. Women more frequently consulted their conception with a doctor post-transplantation (74 versus 88%, p = .064). The number of unplanned pregnancies decreased post-transplantation (34 versus 20%, p = .051). The mean time elapsed from an organ transplant to unintended conception was 27.0 ± 12.5 (3.0-63.0) months. Women with longer (>24 months) rather than shorter (≤24 months) time elapsed from the transplant became pregnant less frequently (38 versus 15%, p = .060). In 70% (38/54) of unplanned pregnancies women did not use any birth control. All cases of conceptions within the post-transplant year were unintentional. Every third woman, who underwent the transplantation up to 1 year before the study enrolment, was unaware of the necessity to prevent the pregnancy.Conclusions: Although unwanted pregnancies occur more frequently in the early post-transplant period, it seems that women after kidney or liver transplantation seem to plan their pregnancies more carefully.
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Affiliation(s)
| | - Natalia Mazanowska
- 1st Department of Obstetrics and Gynaecology, Medical University of Warsaw, Warsaw, Poland
| | | | - Miroslaw Wielgos
- 1st Department of Obstetrics and Gynaecology, Medical University of Warsaw, Warsaw, Poland
| | - Bronislawa Pietrzak
- 1st Department of Obstetrics and Gynaecology, Medical University of Warsaw, Warsaw, Poland
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12
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Szpotanska-Sikorska M, Mazanowska N, Madej A, Kociszewska-Najman B, Wielgos M, Pietrzak B. Reproductive life planning in women after kidney or liver transplantation. Clin Transplant 2018; 32:e13378. [DOI: 10.1111/ctr.13378] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 07/10/2018] [Accepted: 08/06/2018] [Indexed: 10/28/2022]
Affiliation(s)
| | - Natalia Mazanowska
- First Department of Obstetrics and Gynecology; Medical University of Warsaw; Warsaw Poland
| | - Anna Madej
- First Department of Obstetrics and Gynecology; Medical University of Warsaw; Warsaw Poland
| | | | - Miroslaw Wielgos
- First Department of Obstetrics and Gynecology; Medical University of Warsaw; Warsaw Poland
| | - Bronislawa Pietrzak
- First Department of Obstetrics and Gynecology; Medical University of Warsaw; Warsaw Poland
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13
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Magro JTJ, Mendes KDS, Galvão CM. Sexual aspects of liver transplant candidates and recipients: evidence available in the literature1. Rev Lat Am Enfermagem 2018; 26:e3033. [PMID: 30183871 PMCID: PMC6136547 DOI: 10.1590/1518-8345.2744.3033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 05/16/2018] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE to analyze the evidence available in the literature on the alterations in the sexuality of candidates and recipients of liver transplantation. METHOD integrative review of the literature with search for primary studies in the databases MEDLINE (via PUBMED), CINAHL e LILACS, published in English, Portuguese and Spanish. RESULTS the 16 primary studies included were grouped into three categories: 1) female sexuality (n=5), 2) male sexuality (n=5) and 3) male and female sexuality (n=6). In category 1, the subjects investigated were contraception, pregnancy, sexual dysfunction, presence of gynecological symptoms and sexually transmitted infections. In category 2, the main focus of the studies was erectile dysfunction, sexual desire and satisfaction, and consequences of the immunosuppressive regimen with mycophenolic acid in men. In category 3, the evaluation of sexual function was the main topic. CONCLUSION the scientific evidence generated provides support to encourage health professionals to incorporate the topic of sexuality in the routine of care. Knowledge gaps were identified and new studies should be conducted in order to implement interventions to prevent, minimize and/or control changes related to the patient's sexuality.
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Affiliation(s)
- Jennifer Tatisa Jubileu Magro
- MSc, RN, Hospital das Clínicas, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | - Karina Dal Sasso Mendes
- PhD, RN, Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, PAHO/WHO Collaborating Centre for Nursing Research Development, Ribeirão Preto, SP, Brazil
| | - Cristina Maria Galvão
- PhD, Full Professor, Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, PAHO/WHO Collaborating Centre for Nursing Research Development, Ribeirão Preto, SP, Brazil
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14
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Ahmed SB, Vitek WS, Holley JL. Fertility, Contraception, and Novel Reproductive Technologies in Chronic Kidney Disease. Semin Nephrol 2018; 37:327-336. [PMID: 28711071 DOI: 10.1016/j.semnephrol.2017.05.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Chronic kidney disease (CKD) affects hypothalamic-pituitary-gonadal axis function, leading to menstrual abnormalities, sexual dysfunction, functional menopause, and loss of fertility. Pregnancy in a patient with CKD is associated with a higher risk of complications to both the mother and the fetus, highlighting the importance of contraceptive counseling at all stages of CKD. There has been limited research on the safety and efficacy of different contraceptive methods in the CKD population, and it is important to tailor the choice of contraception to the patient's lifestyle and comorbidity status. Cyclophosphamide is a commonly used immunosuppressive agent that impairs fertility in a dose-dependent fashion, with greater impact in older women of child-bearing age. Strategies to reduce the impact of cyclophosphamide on ovarian reserve as well as fertility preservation technologies are options to consider when treating immune-mediated CKD. A multidisciplinary approach in counseling the woman with CKD who wishes to contemplate or avoid pregnancy is necessary to optimize outcomes. Further research in this important area is required.
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Affiliation(s)
- Sofia B Ahmed
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada; Alberta Kidney Disease Network, Alberta, Canada; Libin Cardiovascular Institute of Alberta, Calgary, Alberta, Canada.
| | - Wendy S Vitek
- Department of Obstetrics and Gynecology, University of Rochester Medical Center, Rochester, NY
| | - Jean L Holley
- Department of Medicine, University of Illinois, Urbana-Champaign, IL
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15
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Szpotanska-Sikorska M, Mazanowska N, Staruch M, Wielgos M, Pietrzak B. The observational study of selected sexual behaviour issues in female organ transplant recipients. SEXUAL & REPRODUCTIVE HEALTHCARE 2017; 12:47-50. [PMID: 28477931 DOI: 10.1016/j.srhc.2017.02.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 02/12/2017] [Accepted: 02/21/2017] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To investigate sexual behaviour in women following solid organ transplantation. STUDY DESIGN A cross-sectional single-centre survey study of 230 female organ transplant recipients, aged 18-45years. MAIN OUTCOME MEASURES Sexual behaviour, contraceptive awareness and methods of birth control. RESULTS 205 females declared to be post their sexual initiation. The mean age at sexual initiation in our study population was 20.3±3.3years (range: 14-32). Fifty-three percent (122/230) of the patients declared that they had only one sexual partner at enrolment. After transplantation female organ recipients became more sexually active (71% vs. 83%; p=0.018). The frequency of sexual intercourse decreased significantly in the post-transplant period (p=0.004). In the group of sexually active females before transplantation the frequency of sexual intercourses decreased significantly in the post-transplant period (mean Δ -0.16±0.79; p=0.004). An increase or lack of change in the frequency of sexual intercourse was noted amongst younger transplant-recipients (OR: 0.91; 95%CI 0.86-0.97) and women with effective birth control methods post-transplantation (OR: 3.68; 95%CI 1.60-8.49). CONCLUSION Sexual education of organ transplant recipients is necessary, mainly in younger patients, who present to be more sexually active, thus they need to be taught about effective family planning.
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Affiliation(s)
| | - Natalia Mazanowska
- 1st Department of Obstetrics and Gynaecology, Medical University of Warsaw, Poland.
| | - Monika Staruch
- 1st Department of Obstetrics and Gynaecology, Medical University of Warsaw, Poland
| | - Miroslaw Wielgos
- 1st Department of Obstetrics and Gynaecology, Medical University of Warsaw, Poland
| | - Bronislawa Pietrzak
- 1st Department of Obstetrics and Gynaecology, Medical University of Warsaw, Poland
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16
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Sridhar A, Cwiak CA, Kaunitz AM, Allen RH. Contraceptive Considerations for Women with Gastrointestinal Disorders. Dig Dis Sci 2017; 62:54-63. [PMID: 27885460 DOI: 10.1007/s10620-016-4383-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Accepted: 11/15/2016] [Indexed: 12/19/2022]
Abstract
Gastroenterologists are in a unique position to assist women with chronic gastrointestinal disorders in order to optimize their health prior to pregnancy. Women, whether with chronic conditions or not, and their infants are more likely to be healthy when pregnancies are planned. Achieving a planned pregnancy at the ideal time or preventing pregnancy altogether requires the use of appropriate contraceptives. There is a broad range of contraceptives available to women in the USA, and the majority of women with digestive diseases will be candidates for all effective methods. Guidance from the Centers for Disease Control and Prevention aids clinicians in prescribing appropriate contraceptives to women with medical disorders. This review will focus on contraception for women with inflammatory bowel disease and chronic liver disease, including liver transplant.
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Affiliation(s)
- Aparna Sridhar
- The Department of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, 10833 Le Conte Ave CHS 22-229, Los Angeles, CA, 90095, USA
| | - Carrie A Cwiak
- The Department of Gynecology and Obstetrics, Emory University School of Medicine, 49 Jesse Hill Jr. Drive SE, Atlanta, GA, 30303, USA
| | - Andrew M Kaunitz
- Department of Obstetrics and Gynecology, University of Florida College of Medicine-Jacksonville, 653-1 W. 8th Street, Jacksonville, FL, 32209, USA
| | - Rebecca H Allen
- The Department of Obstetrics and Gynecology, Warren Alpert Medical School of Brown University, 101 Dudley Street, Providence, RI, 02905, USA.
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17
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Jabiry-Zieniewicz Z, Dabrowski FA, Pietrzak B, Wyzgal J, Bomba-Opoń D, Zieniewicz K, Wielgos M. Pregnancy in the liver transplant recipient. Liver Transpl 2016; 22:1408-17. [PMID: 27197796 DOI: 10.1002/lt.24483] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 04/28/2016] [Accepted: 05/12/2016] [Indexed: 12/27/2022]
Abstract
During gestation, the woman's body undergoes various changes, and the line between physiology and pathology is very thin even in healthy women. Today, many of the liver transplant recipients are young women, who at one point in their lives may consider the possibility of pregnancy. Clinicians have to counsel them about the time of conception, the risk of miscarriage, the deterioration of the mother's health status, and the risk of birth defects. This review, based on our 20 years of clinical experience and up-to-date literature, provides comprehensive guidelines on pregnancy management in liver transplant recipients. Pregnancy in liver transplant recipients is possible but never physiological. Proper management and pharmacotherapy lowers the incidence of complications and birth defects. Critical factors for perinatal success include stable graft function before pregnancy, proper preparation for pregnancy, and cautious observation during its course. Liver Transplantation 22 1408-1417 2016 AASLD.
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Affiliation(s)
| | | | - Bronislawa Pietrzak
- 1st Department of Obstetrics and Gynecology, Medical University of Warsaw, Warsaw, Poland
| | - Janusz Wyzgal
- Department of Nephrological Nursing, Medical University of Warsaw, Warsaw, Poland
| | - Dorota Bomba-Opoń
- 1st Department of Obstetrics and Gynecology, Medical University of Warsaw, Warsaw, Poland
| | - Krzysztof Zieniewicz
- Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Warsaw, Poland
| | - Miroslaw Wielgos
- 1st Department of Obstetrics and Gynecology, Medical University of Warsaw, Warsaw, Poland
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18
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