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Mustafa MS, Noorani A, Abdul Rasool A, Tashrifwala FAA, Jayaram S, Raja S, Jawed F, Siddiq MU, Shivappa SG, Hameed I, Dadana S. Pregnancy outcomes in renal transplant recipients: A systematic review and meta-analysis. WOMEN'S HEALTH (LONDON, ENGLAND) 2024; 20:17455057241277520. [PMID: 39287599 PMCID: PMC11418342 DOI: 10.1177/17455057241277520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Revised: 07/21/2024] [Accepted: 08/07/2024] [Indexed: 09/19/2024]
Abstract
BACKGROUND Kidney transplantation is a superior treatment for end-stage renal disease (ESRD), compared with hemodialysis, offering better quality of life and birth outcomes in women with ESRD and lower fertility rates. OBJECTIVES To investigate the pregnancy, maternal, fetal, and graft outcomes following kidney transplantation in women with ESRD and evaluate the improvements in quality of life and associated risks. DESIGN A systematic review and meta-analysis performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and the Meta-analysis of Observational Studies in Epidemiology guidelines. DATA SOURCES AND METHODS A thorough search of multiple databases, including PubMed, Embase, Scopus, ATC abstracts, and Cochrane Central Register of Controlled Trials, was conducted to identify studies that analyzed pregnancy outcomes in kidney transplant patients. The search was conducted from the inception of each database to January 2023. RESULTS The study reviewed 109 studies that evaluated 7708 pregnancies in 5107 women who had undergone renal transplantation. Of these, 78.48% resulted in live births, 9.68% had induced abortion, and 68.67% had a cesarean section. Miscarriage occurred in 12.54%, preeclampsia in 20.87%, pregnancy-induced hypertension in 24.30%, gestational diabetes in 5.08%, and preterm delivery in 45.30% of cases. Of the 853 recipients, 123 had graft loss after pregnancy and 8.06% suffered acute rejection. CONCLUSION Pregnancy after kidney transplantation is associated with risks for mother and fetus; however, live births are still possible. In addition, there are reduced overall risks of stillbirths, miscarriages, neonatal deaths, and gestational diabetes. REGISTRATION PROSPERO (CRD42024541659).
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Affiliation(s)
| | - Amber Noorani
- Department of Biochemistry, Jinnah Sindh Medical University, Karachi, Pakistan
| | - Aniqa Abdul Rasool
- Department of Pediatrics and Child Health, Aga Khan University Hospital, Karachi, Pakistan
| | | | - Shubha Jayaram
- Department of Biochemistry, Mysore Medical College and Research Institute, Mysore, Karnataka, India
| | - Sandesh Raja
- Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Fatima Jawed
- Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | | | | | - Ishaque Hameed
- Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Sriharsha Dadana
- Department of Hospital Medicine, Cheyenne Regional Medical Center, Cheyenne, WY, USA
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Ponticelli C, Zaina B, Moroni G. Planned Pregnancy in Kidney Transplantation. A Calculated Risk. J Pers Med 2021; 11:jpm11100956. [PMID: 34683097 PMCID: PMC8537874 DOI: 10.3390/jpm11100956] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 09/23/2021] [Accepted: 09/23/2021] [Indexed: 12/13/2022] Open
Abstract
Pregnancy is not contraindicated in kidney transplant women but entails risks of maternal and fetal complications. Three main conditions can influence the outcome of pregnancy in transplant women: preconception counseling, maternal medical management, and correct use of drugs to prevent fetal toxicity. Preconception counseling is needed to prevent the risks of an unplanned untimely pregnancy. Pregnancy should be planned ≥2 years after transplantation. The candidate for pregnancy should have normal blood pressure, stable serum creatinine <1.5 mg/dL, and proteinuria <500 mg/24 h. Maternal medical management is critical for early detection and treatment of complications such as hypertension, preeclampsia, thrombotic microangiopathy, graft dysfunction, gestational diabetes, and infection. These adverse outcomes are strongly related to the degree of kidney dysfunction. A major issue is represented by the potential fetotoxicity of drugs. Moderate doses of glucocorticoids, azathioprine, and mTOR inhibitors are relatively safe. Calcineurin inhibitors (CNIs) are not associated with teratogenicity but may increase the risk of low birth weight. Rituximab and eculizumab should be used in pregnancy only if the benefits outweigh the risk for the fetus. Renin-angiotensin system inhibitors, mycophenolate, bortezomib, and cyclophosphamide can lead to fetal toxicity and should not be prescribed to pregnant women.
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Affiliation(s)
- Claudio Ponticelli
- Nephrology, Ospedale Maggiore Policlinico, 20122 Milan, Italy
- Correspondence:
| | - Barbara Zaina
- Department of Obstetrics and Gynecology, IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy;
| | - Gabriella Moroni
- Department of Biomedical Sciences, IRCCS Humanitas Research Hospital, Humanitas University, 20122 Milan, Italy;
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Kallapur A, Jang C, Yin O, Mei JY, Afshar Y. Pregnancy care in solid organ transplant recipients. Int J Gynaecol Obstet 2021; 157:502-513. [PMID: 34245162 DOI: 10.1002/ijgo.13819] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 06/28/2021] [Accepted: 07/08/2021] [Indexed: 12/12/2022]
Abstract
Recipients of solid organ transplants who become pregnant represent an obstetrically high-risk population. Preconception planning and effective contraception tailored to the individual patient are critical in this group. Planned pregnancies improve both maternal and neonatal outcomes and provide a window of opportunity to mitigate risk and improve lifelong health. Optimal management of these pregnancies is not well defined. Common pregnancy complications after transplantation include hypertension, preterm birth, infection, and metabolic disease. Multidisciplinary preconception and prepartum management, and counseling decrease complications and benefit the maternal-neonatal dyad.
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Affiliation(s)
- Aneesh Kallapur
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Christine Jang
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Ophelia Yin
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Jenny Y Mei
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Yalda Afshar
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
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4
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Fertility and Pregnancy in End Stage Kidney Failure Patients and after Renal Transplantation: An Update. TRANSPLANTOLOGY 2021. [DOI: 10.3390/transplantology2020010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Sexual life and fertility are compromised in end stage kidney disease both in men and in women. Successful renal transplantation may rapidly recover fertility in the vast majority of patients. Pregnancy modifies anatomical and functional aspects in the kidney and represents a risk of sensitization that may cause acute rejection. Independently from the risks for the graft, pregnancy in kidney transplant may cause preeclampsia, gestational diabetes, preterm delivery, and low birth weight. The nephrologist has a fundamental role in correct counseling, in a correct evaluation of the mother conditions, and in establishing a correct time lapse between transplantation and conception. Additionally, careful attention must be given to the antirejection therapy, avoiding drugs that could be dangerous to the newborn. Due to the possibility of medical complications during pregnancy, a correct follow-up should be exerted. Even if pregnancy in transplant is considered a high risk one, several data and studies document that in the majority of patients, the long-term follow-up and outcomes for the graft may be similar to that of non-pregnant women.
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van Buren MC, Schellekens A, Groenhof TKJ, van Reekum F, van de Wetering J, Paauw ND, Lely AT. Long-term Graft Survival and Graft Function Following Pregnancy in Kidney Transplant Recipients: A Systematic Review and Meta-analysis. Transplantation 2020; 104:1675-1685. [PMID: 32732847 PMCID: PMC7373482 DOI: 10.1097/tp.0000000000003026] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 09/13/2019] [Accepted: 09/24/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND The incidence of pregnancy in kidney transplantation (KT) recipients is increasing. Studies report that the incidence of graft loss (GL) during pregnancy is low, but less data are available on long-term effects of pregnancy on the graft. METHODS Therefore, we performed a meta-analysis and systematic review on GL and graft function, measured by serum creatinine (SCr), after pregnancy in KT recipients, stratified in years postpartum. Furthermore, we included studies of nulliparous KT recipients. RESULTS Our search yielded 38 studies on GL and 18 studies on SCr. The pooled incidence of GL was 9.4% within 2 years after pregnancy, 9.2% within 2-5 years, 22.3% within 5-10 years, and 38.5% >10 years postpartum. In addition, our data show that, in case of graft survival, SCr remains stable over the years. Only within 2 years postpartum, Δ SCr was marginally higher (0.18 mg/dL, 95%CI [0.05-0.32], P = 0.01). Furthermore, no differences in GL were observed in 10 studies comparing GL after pregnancy with nulliparous controls. Systematic review of the literature showed that mainly prepregnancy proteinuria, hypertension, and high SCr are risk factors for GL. CONCLUSIONS Overall, these data show that pregnancy after KT has no effect on long-term graft survival and only a possible effect on graft function within 2 years postpartum. This might be due to publication bias. No significant differences were observed between pre- and postpartum SCr at longer follow-up intervals.
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Affiliation(s)
- Marleen C van Buren
- Department of Internal Medicine, Nephrology and Renal Transplantation, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Anouk Schellekens
- Department of Obstetrics, Wilhelmina Children's Hospital Birth Center, University Medical Center Utrecht, Utrecht
| | - T Katrien J Groenhof
- Department of Cardiovascular Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht
| | | | - Jacqueline van de Wetering
- Department of Obstetrics, Wilhelmina Children's Hospital Birth Center, University Medical Center Utrecht, Utrecht
| | - Nina D Paauw
- Department of Internal Medicine, Nephrology and Renal Transplantation, Erasmus Medical Center, Rotterdam, The Netherlands
| | - A Titia Lely
- Department of Internal Medicine, Nephrology and Renal Transplantation, Erasmus Medical Center, Rotterdam, The Netherlands
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Ying J, Li L, Zhai Y, Wang S, Li X. Pregnancy Outcomes After Renal Transplantation: A Retrospective Case Series. ACTA ACUST UNITED AC 2020; 1:55-59. [PMID: 33786473 PMCID: PMC7784730 DOI: 10.1089/whr.2019.0002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Objective: To investigate the clinical characteristics and outcomes of pregnancies after renal transplantation (RT). Materials and Methods: A retrospective study was employed. Data of obstetric, transplantation, pregnancy outcomes, and maternal and neonatal complications from 2000 to 2017 were obtained from a single obstetrics center. Results: Eleven cases of pregnancies were included: the mean age at conception was 31.27 ± 3.44 (26–36, median 32) years and interval from RT to pregnancy was 51.18 ± 30.65 (25–132, median 38) months. The nine successful pregnancies (9/11) were all in women who maintained their immunosuppressive regimens. All infants were delivered by cesarean section for severe pre-eclampsia in eight cases and placental abruption in one case at a mean gestational age of 34.67 ± 1.41 (30–38) weeks and a median birth weight of 2374.56 ± 569.00 (1,325–3,070) g. Four of nine infants had low birth weight, and six of nine infants underwent premature delivery. The babies had no postpartum complications or congenital anomalies at follow-up period (12–180 months, mean 98.18 ± 54.73 months). One infant was transferred to the neonatal intensive care unit for neonatal asphyxia. Nine cases were uncomplicated at the first trimester, but developed severe pre-eclampsia after the second trimester. Two patients had allograft dysfunction from the second trimester and delivered at the third trimester, and then lost the allografts at 2 and 6 years postdelivery, respectively, whereas the other seven patients had well-functioning allografts at an average follow-up of 108 months. Two patients who decreased their immunosuppressive regimens and developed severe complications had second trimester therapeutic abortion and lost their allografts Conclusions: During pregnancy, RT patients exhibit risks for the mother, fetus, newborn, and allograft. Decreasing immunosuppressors leads to poor outcomes. With proper peritransplant and periconceptional counseling, these patients can have acceptable pregnancy outcomes.
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Affiliation(s)
- Jiang Ying
- Department of Obstetrics and Gynecology, Chaoyang Hospital Affiliated to Capital Medical University, Beijing, China
| | - Lin Li
- Department of Obstetrics and Gynecology, Chaoyang Hospital Affiliated to Capital Medical University, Beijing, China
| | - Yan Zhai
- Department of Obstetrics and Gynecology, Chaoyang Hospital Affiliated to Capital Medical University, Beijing, China
| | - Shuzhen Wang
- Department of Obstetrics and Gynecology, Chaoyang Hospital Affiliated to Capital Medical University, Beijing, China
| | - Xiaobei Li
- Department of Urinary Surgery, Chaoyang Hospital Affiliated to Capital Medical University, Beijing, China
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Shah S, Venkatesan RL, Gupta A, Sanghavi MK, Welge J, Johansen R, Kean EB, Kaur T, Gupta A, Grant TJ, Verma P. Pregnancy outcomes in women with kidney transplant: Metaanalysis and systematic review. BMC Nephrol 2019; 20:24. [PMID: 30674290 PMCID: PMC6345071 DOI: 10.1186/s12882-019-1213-5] [Citation(s) in RCA: 106] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Accepted: 01/15/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Reproductive function in women with end stage renal disease generally improves after kidney transplant. However, pregnancy remains challenging due to the risk of adverse clinical outcomes. METHODS We searched PubMed/MEDLINE, Elsevier EMBASE, Scopus, BIOSIS Previews, ISI Science Citation Index Expanded, and the Cochrane Central Register of Controlled Trials from date of inception through August 2017 for studies reporting pregnancy with kidney transplant. RESULTS Of 1343 unique studies, 87 met inclusion criteria, representing 6712 pregnancies in 4174 kidney transplant recipients. Mean maternal age was 29.6 ± 2.4 years. The live-birth rate was 72.9% (95% CI, 70.0-75.6). The rate of other pregnancy outcomes was as follows: induced abortions (12.4%; 95% CI, 10.4-14.7), miscarriages (15.4%; 95% CI, 13.8-17.2), stillbirths (5.1%; 95% CI, 4.0-6.5), ectopic pregnancies (2.4%; 95% CI, 1.5-3.7), preeclampsia (21.5%; 95% CI, 18.5-24.9), gestational diabetes (5.7%; 95% CI, 3.7-8.9), pregnancy induced hypertension (24.1%; 95% CI, 18.1-31.5), cesarean section (62.6, 95% CI 57.6-67.3), and preterm delivery was 43.1% (95% CI, 38.7-47.6). Mean gestational age was 34.9 weeks, and mean birth weight was 2470 g. The 2-3-year interval following kidney transplant had higher neonatal mortality, and lower rates of live births as compared to > 3 year, and < 2-year interval. The rate of spontaneous abortion was higher in women with mean maternal age < 25 years and > 35 years as compared to women aged 25-34 years. CONCLUSION Although the outcome of live births is favorable, the risks of maternal and fetal complications are high in kidney transplant recipients and should be considered in patient counseling and clinical decision making.
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Affiliation(s)
- Silvi Shah
- Division of Nephrology Kidney C.A.R.E. Program, University of Cincinnati, 231 Albert Sabin Way, MSB 6112, Cincinnati, OH 45267 USA
| | | | - Ayank Gupta
- Department of Environmental Health, University of Cincinnati, Cincinnati, OH USA
| | - Maitrik K. Sanghavi
- Department of Environmental Health, University of Cincinnati, Cincinnati, OH USA
| | - Jeffrey Welge
- Health Sciences Library, College of Medicine, University of Cincinnati, Cincinnati, OH USA
| | - Richard Johansen
- Department of Environmental Health, University of Cincinnati, Cincinnati, OH USA
| | - Emily B. Kean
- Department of Environmental Health, University of Cincinnati, Cincinnati, OH USA
| | - Taranpreet Kaur
- Division of Nephrology Kidney C.A.R.E. Program, University of Cincinnati, 231 Albert Sabin Way, MSB 6112, Cincinnati, OH 45267 USA
| | - Anu Gupta
- Buffalo Medical Group, Buffalo, NY USA
| | - Tiffany J. Grant
- Department of Environmental Health, University of Cincinnati, Cincinnati, OH USA
| | - Prasoon Verma
- Division of Neonatology, Cincinnati Children’s Hospital and Medical Center, Cincinnati, OH USA
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Wiles K, Lightstone L. Glomerular Disease in Women. Kidney Int Rep 2018; 3:258-270. [PMID: 29725630 PMCID: PMC5932310 DOI: 10.1016/j.ekir.2018.01.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 01/26/2018] [Accepted: 01/27/2018] [Indexed: 12/28/2022] Open
Abstract
Gender differences exist in the prevalence of glomerular diseases. Data based on histological diagnosis underestimate the prevalence of preeclampsia, which is almost certainly the commonest glomerular disease in the world, and uniquely gender-specific. Glomerular disease affects fertility via disease activity, the therapeutic use of cyclophosphamide, and underlying chronic kidney disease. Techniques to preserve fertility during chemotherapy and risk minimization of artificial reproductive techniques are considered. The risks, benefits, and effectiveness of different contraceptive methods for women with glomerular disease are outlined. Glomerular disease increases the risk of adverse outcomes in pregnancy, including preeclampsia; yet, diagnosis of preeclampsia is complicated by the presence of hypertension and proteinuria that precede pregnancy. The role of renal biopsy in pregnancy is examined, in addition to the use of emerging angiogenic biomarkers. The safety of drugs prescribed for glomerular disease in relation to reproductive health is detailed. The impact of both gender and pregnancy on long-term prognosis is discussed.
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Affiliation(s)
- Kate Wiles
- Obstetric Nephrology, Guy’s and St. Thomas’ NHS Trust and King’s College London, London, UK
| | - Liz Lightstone
- Division of Immunology and Inflammation, Department of Medicine, Imperial College London, Hammersmith Campus, London, UK
- Correspondence: Liz Lightstone, Section of Renal Medicine and Vascular Inflammation, Department of Medicine, Imperial College London, Hammersmith Campus, Du Cane Road, London W12 0NN, UK.
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Pregnancy and Renal Transplantation. Nephrourol Mon 2018. [DOI: 10.5812/numonthly.63052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Amine BHH, Haythem S, Kais H, Radhouane R. Pregnancy after renal transplantation: a retrospective study at the military hospital of Tunis from 1992 to 2011. Pan Afr Med J 2018. [PMID: 29541287 PMCID: PMC5847131 DOI: 10.11604/pamj.2017.28.137.6287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Introduction Our study objective was to analyze the optimum conditions for pregnancy in kidney transplanted women. For that, we conducted a retrospective study was from 1992 to April 2011 about 17 pregnancies in 12 kidney transplanted patients followed in the Department of Obstetrics and Gynecology and Organ Transplant Unit of the Military Hospital of Tunis. Methods We studied nephrological parameters and obstetric pathologies encountered during pregnancy and the potential impact of pregnancy on graft. Our main outcome measures were: time between renal transplantation and conception, birth of a living child, renal graft defect. Results The mean age at the time of renal transplantation was 30.11 years. The average age at the time of conception is 34.23 years. The average time between renal transplantation and the occurrence of pregnancy was 46.94 months. More than 40% of pregnancies were not planned. Of the 17 pregnancies, 12 have advanced beyond the first trimester with 91.6% resulting in the birth of a living child. Toxemia was found in 60% of cases, low birth weight in 50%, preterm in 30% and intrauterine growth retardation in 20% of cases. Cesarean section was indicated in all cases. Graft survival was 90% with a mean of 6 years after delivery. Conclusion Pregnancy in kidney transplanted patients is a high-risk pregnancy, but pregnancy does not appear to affect graft function through certain conditions.
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Affiliation(s)
- Ben Haj Hassine Amine
- Department of Gynecology and Obstetrics, Principal Military Hospital of Instruction of Tunis, Tunisia
| | - Siala Haythem
- Department of Gynecology and Obstetrics, Principal Military Hospital of Instruction of Tunis, Tunisia
| | - Harzallah Kais
- Organ Transplant Unit - Principal Military Hospital of Instruction of Tunis, Tunisia
| | - Rachdi Radhouane
- Department of Gynecology and Obstetrics, Principal Military Hospital of Instruction of Tunis, Tunisia
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Morales-Buenrostro LE, Alberu J, Mancilla-Urrea E, Vélez-García A, Espinoza-Pérez R, Cruz-Santiago J, Parra-Michel R, Parra-Avila I, Flores-Nava G, Caballero-Andrade G, Niebla-Cardenas A, Pérez-Avendaño R, Angulo-Dominguez A, Lascarez S, Sánchez-Román S. Intellectual performance of kidney transplant recipients’ offspring: a cross-sectional, multicenter study. J Matern Fetal Neonatal Med 2017; 32:542-549. [DOI: 10.1080/14767058.2017.1384805] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Luis Eduardo Morales-Buenrostro
- Nephrology and Mineral Metabolism Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Tlalpan, Mexico
| | - Josefina Alberu
- Transplant Department, Instituto Nacional de Ciencias Médicas y Nutricion Salvador Zubirán, Tlalpan, Mexico
| | - Eduardo Mancilla-Urrea
- Kidney Transplant Program, Instituto Nacional de Cardiología Ignacio Chavez, Mexico, Mexico
| | - Alicia Vélez-García
- Neuropsychology Laboratory, Universidad Nacional Autónoma de México, Coyoacan, Mexico
| | - Ramon Espinoza-Pérez
- Hospital de Especialidades Centro Medico Nacional Siglo XXI, Mexico City, Mexico
| | - Jose Cruz-Santiago
- Transplant Department, Hospital de Especialidades CMN La Raza, Mexico City, Mexico
| | | | - Idalia Parra-Avila
- Nephrology Service, Hospital General Regional No 46, Guadalajara, Mexico
| | - Gerardo Flores-Nava
- Division of Clinical Pediatrics, Hospital General Dr Manuel Gea González, Ciudad de Mexico, Mexico
| | - Gabriela Caballero-Andrade
- Neurology and Psychiatry Department, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Tlalpan, Mexico
| | - Alfonssina Niebla-Cardenas
- Neurology and Psychiatry Department, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Tlalpan, Mexico
| | - Roberto Pérez-Avendaño
- Neurology and Psychiatry Department, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Tlalpan, Mexico
| | - Alejandro Angulo-Dominguez
- Neurology and Psychiatry Department, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Tlalpan, Mexico
| | - Silvia Lascarez
- Neurology and Psychiatry Department, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Tlalpan, Mexico
| | - Sofía Sánchez-Román
- Neurology and Psychiatry Department, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Tlalpan, Mexico
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Yuksel Y, Tekin S, Yuksel D, Duman I, Sarier M, Yucetin L, Turan E, Celep H, Ugurlu T, Inal MM, Asuman YH, Demirbas A. Pregnancy and Delivery in the Sequel of Kidney Transplantation: Single-Center Study of 8 Years' Experience. Transplant Proc 2017; 49:546-550. [PMID: 28340831 DOI: 10.1016/j.transproceed.2017.02.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Depending on hyphothalamic, hyphophyseal, and gonadal axis dysfunction, anovulatory irregular cycles occur and the probability of pregnancy decreases in the patients with chronic kidney disease (CKD). Maternal mortality and morbidity rates are increased in CKD patients; the risk of premature delivery is 70% and the risk of preeclampsia is 40% more than normal among those with a creatine level of >2.5 mg/dL. METHODS If a pregnancy is expected in the sequel of kidney transplantation (KT), a multidisciplinary team approach should be adopted and both the gynecologist and the nephrologist should follow the patient simultaneously. Among 3883 patients who underwent KT at Antalya Medical Park Hospital Transplantion Department between November 2009 and October 2016, the records of 550 female patients between the ages of 18 and 40 years were examined retrospectively; 31 patients who complied with these criteria were included in the study group. In 6 of these patients who had an unplanned pregnancy, medical abortion was performed after the families were informed about the possible fetal anomalies caused by the use of everolimus in the first trimester, and they were excluded from the study (pregnant group). The control group consisted of 43 patients who had a KT and became pregnant, and of those who had recently undergone KT and shared similarities regarding age, CKD etiology, duration of dialysis, and number of transplants. RESULTS In both groups, the ages of the patients, their follow-up span and dialysis duration, tissue compatibility, age of the donor, and time elapsed until the pregnancy was analyzed, whereas in the control group, creatinine levels in the first, second, third, and fourth years after the KT were reviewed. Additionally, in the pregnant group, creatinine levels of the first, second, and third trimesters; delivery week; birth weight of the baby; APGAR scores of the first minute; postnatal creatinine levels of first, second, and third years; and prenatal, maternal, and postnatal acute rejections were reviewed. We measured the creatine clearance by use of the Cockcroft-Gault formula in the pregnancy group before pregnancy and during delivery [Cockcroft-Gault formula: (140 - age) × body weight (kg)/72 × plasma creatine level (mg/dL) × 0.85]. CONCLUSIONS Pregnancy after KT is risky both for the mother and the baby; however, if planned and followed in coordination within an experienced center, both the pregnancy period and the birth process can occur without distress.
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Affiliation(s)
- Y Yuksel
- Department of General Surgery and Transplantation, Medical Park Hospital, Antalya, Turkey.
| | - S Tekin
- Department of General Surgery, Faculty of Medicine, Kemerburgaz University, Istanbul, Turkey
| | - D Yuksel
- Department of Anesthesia, and Reanimasyon Unit, Training and Research Hospital, Antalya, Turkey
| | - I Duman
- Department of Urology, Faculty of Medicine, Kemerburgaz University, Istanbul, Turkey
| | - M Sarier
- Department of Urology, Faculty of Medicine, Kemerburgaz University, Istanbul, Turkey
| | - L Yucetin
- Department of General Surgery and Transplantation, Medical Park Hospital, Antalya, Turkey
| | - E Turan
- Department of General Surgery and Transplantation, Medical Park Hospital, Antalya, Turkey
| | - H Celep
- Department of General Surgery and Transplantation, Medical Park Hospital, Antalya, Turkey
| | - T Ugurlu
- Department of Obstetrics and Gynecology, Medical Park Hospital, Antalya, Turkey
| | - M M Inal
- Department of Obstetrics and Gynecology, Faculty of Medicine, Kemerburgaz University, Istanbul, Turkey
| | - Y H Asuman
- Department of Nephrology and Transplantation, Medical Park Hospital, Antalya, Turkey
| | - A Demirbas
- Department of General Surgery and Transplantation, Medical Park Hospital, Antalya, Turkey
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14
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Pregnancy outcome in renal transplant recipients: Indian scenario. INDIAN JOURNAL OF TRANSPLANTATION 2016. [DOI: 10.1016/j.ijt.2016.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Mishra VV, Nanda SS, Mistry K, Choudhary S, Aggarwal R, Vyas BM. An Overview on Fertility Outcome in Renal Transplant Recipients. J Obstet Gynaecol India 2016; 66:330-4. [PMID: 27651625 DOI: 10.1007/s13224-016-0919-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Accepted: 05/30/2016] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND The number of patients undergoing renal transplant are increasing with time. Most of these patients fall in the reproductive age group, who are going to conceive sooner or later. But there are few recipients who either are infertile before transplant or became infertile due to underlying renal pathology responsible for transplantation. OBJECTIVE To study fertility outcome in female renal transplant recipients. MATERIALS AND METHODS STUDY DESIGN This is a retrospective study conducted at tertiary health center in Ahmedabad, from 2004 to 2014. INCLUSION CRITERIA Renal transplant recipients in the reproductive age group (20-40 years of age) were followed up in gynecology outdoor patient department. SAMPLE SIZE There were 211 female renal transplant recipients, out of which 113 (53.5 %) patients had complete family, 3 (1.41 %) patients were infertile, 16 (7.58 %) patients have conceived, 33 (15.63 %) patients were lost to follow-up and remaining 46 (21.8 %) did not try for pregnancy. EXCLUSION CRITERIA Unmarried patients, divorced and widow patients were excluded. RESULTS Out of 19 patients, 16 patients conceived and 3 were infertile. The main cause of infertility in these patients was ovarian factor in 2 patients and tubal factor in 1 patient. Among 16 patients, 8 patients had missed abortion, 2 patients had preterm deliveries and 6 patients had term deliveries. CONCLUSION Peritransplant and preconceptional counseling plays an important role for renal transplant recipients to help them understand the effect of renal pathology and transplantation on their fertility. They can have good fertility and pregnancy outcome with optimum functioning graft.
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Affiliation(s)
- Vineet V Mishra
- Department of Obstetrics and Gynaecology, Room No: 31, Institute of Kidney Diseases and Research Centre, Institute of Transplantation Sciences (IKDRC - ITS), B.J. Medical College, Civil Hospital Campus, Ahmedabad, 380016 India
| | - Sakshi S Nanda
- Department of Obstetrics and Gynaecology, Room No: 31, Institute of Kidney Diseases and Research Centre, Institute of Transplantation Sciences (IKDRC - ITS), B.J. Medical College, Civil Hospital Campus, Ahmedabad, 380016 India
| | - Kavita Mistry
- Department of Obstetrics and Gynaecology, Room No: 31, Institute of Kidney Diseases and Research Centre, Institute of Transplantation Sciences (IKDRC - ITS), B.J. Medical College, Civil Hospital Campus, Ahmedabad, 380016 India
| | - Sumesh Choudhary
- Department of Obstetrics and Gynaecology, Room No: 31, Institute of Kidney Diseases and Research Centre, Institute of Transplantation Sciences (IKDRC - ITS), B.J. Medical College, Civil Hospital Campus, Ahmedabad, 380016 India
| | - Rohina Aggarwal
- Department of Obstetrics and Gynaecology, Room No: 31, Institute of Kidney Diseases and Research Centre, Institute of Transplantation Sciences (IKDRC - ITS), B.J. Medical College, Civil Hospital Campus, Ahmedabad, 380016 India
| | - Bhumika M Vyas
- Department of Obstetrics and Gynaecology, Room No: 31, Institute of Kidney Diseases and Research Centre, Institute of Transplantation Sciences (IKDRC - ITS), B.J. Medical College, Civil Hospital Campus, Ahmedabad, 380016 India
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Stoumpos S, McNeill SH, Gorrie M, Mark PB, Brennand JE, Geddes CC, Deighan CJ. Obstetric and long-term kidney outcomes in renal transplant recipients: a 40-yr single-center study. Clin Transplant 2016; 30:673-81. [PMID: 26992458 DOI: 10.1111/ctr.12732] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2016] [Indexed: 11/29/2022]
Abstract
Female renal transplant recipients of childbearing age may ask what the outcomes are for pregnancy and whether pregnancy will affect graft function. We analyzed obstetric and transplant outcomes among renal transplant recipients in our center who have been pregnant between 1973 and 2013. A case-cohort study was performed identifying 83 pairs of pregnant and non-pregnant controls matched for sex, age, transplant vintage, and creatinine. There were 138 pregnancies reported from 89 renal transplant recipients. There were live births in 74% of pregnancies with high prevalence of prematurity (61%), low birth weight (52%), and pre-eclampsia (14%). Lower eGFR (OR 0.98; p = 0.05) and higher uPCR (OR 1.86; p = 0.02) at conception were independent predictors for poor composite obstetric outcome. Lower eGFR (OR 0.98; p = 0.04), higher uPCR (OR 1.50; p = 0.04), and live organ donation (OR 0.35; p = 0.02) were predictors of ≥20% loss of eGFR between immediately pre-pregnancy and one yr after delivery. There was no difference in eGFR at one, five, and 10 yr in pregnant women compared with non-pregnant controls and a pregnancy was not associated with poorer 10-yr transplant or 20-yr patient survival. Despite high rates of obstetric complications, most women had successful pregnancies with good long-term transplant function.
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Affiliation(s)
- Sokratis Stoumpos
- The Glasgow Renal & Transplant Unit, Queen Elizabeth University Hospital, Glasgow, UK
| | - Susan H McNeill
- The Glasgow Renal & Transplant Unit, Queen Elizabeth University Hospital, Glasgow, UK
| | - Morag Gorrie
- The Glasgow Renal & Transplant Unit, Queen Elizabeth University Hospital, Glasgow, UK
| | - Patrick B Mark
- The Glasgow Renal & Transplant Unit, Queen Elizabeth University Hospital, Glasgow, UK.,Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Janet E Brennand
- Department of Obstetrics, Queen Elizabeth University Hospital, Glasgow, UK
| | - Colin C Geddes
- The Glasgow Renal & Transplant Unit, Queen Elizabeth University Hospital, Glasgow, UK
| | - Christopher J Deighan
- The Glasgow Renal & Transplant Unit, Queen Elizabeth University Hospital, Glasgow, UK
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Kwek JL, Tey V, Yang L, Kanagalingam D, Kee T. Renal and obstetric outcomes in pregnancy after kidney transplantation: Twelve-year experience in a Singapore transplant center. J Obstet Gynaecol Res 2015; 41:1337-44. [DOI: 10.1111/jog.12736] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 03/18/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Jia Liang Kwek
- Department of Renal Medicine; Singapore General Hospital; Singapore Singapore
| | - Vanessa Tey
- Yong Loo Lin School of Medicine; National University of Singapore; Singapore Singapore
| | - Liying Yang
- Department of Obstetrics and Gynaecology; Singapore General Hospital; Singapore Singapore
| | - Devendra Kanagalingam
- Department of Obstetrics and Gynaecology; Singapore General Hospital; Singapore Singapore
| | - Terence Kee
- Department of Renal Medicine; Singapore General Hospital; Singapore Singapore
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Josephson MA, McKay DB. Women and transplantation: fertility, sexuality, pregnancy, contraception. Adv Chronic Kidney Dis 2013; 20:433-40. [PMID: 23978550 DOI: 10.1053/j.ackd.2013.06.005] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Revised: 06/14/2013] [Accepted: 06/17/2013] [Indexed: 01/23/2023]
Abstract
Since 1958, thousands of women with kidney transplants have become pregnant. Although most pregnancies in kidney transplant recipients are successful, they are high-risk endeavors. This seems more a function of the associated issues and comorbidities that often affect individuals with kidney transplants (eg, hypertension) or immunosuppression side effects rather than the kidney transplant per se. Regardless of the underlying pathophysiology, these pregnancies are associated with a high rate of preeclampsia diagnoses, preterm deliveries, Cesarean sections, and small-for-gestational-age babies. Given these risks, it is critical to counsel and inform transplant recipients and prospective transplant recipients of childbearing age and their partners regarding many aspects of pregnancy, including the need for contraception to prevent pregnancy after transplant, immunosuppression concerns, and the potential effect of pregnancy on the outcome of the mother, baby, and kidney transplant.
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Kukla A, Issa N, Ibrahim HN. Pregnancy in renal transplantation: Recipient and donor aspects in the Arab world. Arab J Urol 2012; 10:175-81. [PMID: 26558022 PMCID: PMC4442883 DOI: 10.1016/j.aju.2012.02.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2011] [Revised: 02/17/2012] [Accepted: 02/18/2012] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE There are many kidney transplant recipients and living donors of reproductive age, and the prevalence of pregnancies in kidney transplant recipients can reach 55% in the Middle Eastern countries. Living kidney donation is predominant in this region. As the risks and outcomes of pregnancy should be a part of counselling for both recipients and donors, we reviewed available reports on maternal and foetal outcomes in these particular populations. METHODS Information was obtained from retrospective analyses of a large database, and from single-centre reports indexed in PubMed on pregnancy in donors and kidney transplant recipients. The keywords used for the search included 'fertility', 'kidney disease', 'pregnancy', 'maternal/foetal outcomes', 'kidney transplant recipient', 'immunosuppression side-effects', 'living donor' and 'Arab countries'. RESULTS Pregnancies in kidney transplant recipients are most successful in those with adequate kidney function and controlled comorbidities. Similarly to other regions, pregnant recipients in the Middle East had a higher risk of pre-eclampsia (26%) and gestational diabetes (7%) than in the general population. Caesarean section was quite common, with an incidence rate of 61%, and the incidence of pre-term birth reached 46%. CONCLUSIONS Most living donors can have successful pregnancies and should not be routinely discouraged. Women who had pregnancies before and after donation were more likely to have adverse maternal outcomes (gestational diabetes, hypertension, proteinuria, and pre-eclampsia) in the latter, but no adverse foetal outcomes were found after donation. The evaluation before donation should include a gestational history and counselling about the potential risks.
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Affiliation(s)
- Aleksandra Kukla
- Division of Renal Diseases and Hypertension, Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Naim Issa
- Division of Renal Diseases and Hypertension, Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Hassan N Ibrahim
- Division of Renal Diseases and Hypertension, Department of Medicine, University of Minnesota, Minneapolis, MN, USA
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Deshpande NA, James NT, Kucirka LM, Boyarsky BJ, Garonzik-Wang JM, Montgomery RA, Segev DL. Pregnancy outcomes in kidney transplant recipients: a systematic review and meta-analysis. Am J Transplant 2011; 11:2388-404. [PMID: 21794084 DOI: 10.1111/j.1600-6143.2011.03656.x] [Citation(s) in RCA: 224] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Approximately 50,000 women of reproductive age in the United States are currently living after kidney transplantation (KT), and another 2800 undergo KT each year. Although KT improves reproductive function in women with ESRD, studies of post-KT pregnancies are limited to a few voluntary registry analyses and numerous single-center reports. To obtain more generalizable inferences, we performed a systematic review and meta-analysis of articles published between 2000 and 2010 that reported pregnancy-related outcomes among KT recipients. Of 1343 unique studies, 50 met inclusion criteria, representing 4706 pregnancies in 3570 KT recipients. The overall post-KT live birth rate of 73.5% (95%CI 72.1-74.9) was higher than the general US population (66.7%); similarly, the overall post-KT miscarriage rate of 14.0% (95%CI 12.9-15.1) was lower (17.1%). However, complications of preeclampsia (27.0%, 95%CI 25.2-28.9), gestational diabetes (8.0%, 95%CI 6.7-9.4), Cesarean section (56.9%, 95%CI 54.9-58.9) and preterm delivery (45.6%, 95%CI 43.7-47.5) were higher than the general US population (3.8%, 3.9%, 31.9% and 12.5%, respectively). Pregnancy outcomes were more favorable in studies with lower mean maternal ages; obstetrical complications were higher in studies with shorter mean interval between KT and pregnancy. Although post-KT pregnancy is feasible, complications are relatively high and should be considered in patient counseling and clinical decision making.
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Affiliation(s)
- N A Deshpande
- Department of Surgery Department of Epidemiology, Johns Hopkins School of Medicine, Baltimore, MD, USA
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Çelik G, Töz H, Ertilav M, Aşgar N, Özkahya M, Başci A, Hoşcoşkun C. Biochemical Parameters, Renal Function, and Outcome of Pregnancy in Kidney Transplant Recipient. Transplant Proc 2011; 43:2579-83. [DOI: 10.1016/j.transproceed.2011.06.041] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2011] [Revised: 05/06/2011] [Accepted: 06/13/2011] [Indexed: 11/29/2022]
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Sirolimus Used During Pregnancy in a Living Related Renal Transplant Recipient: A Case Report. Transplant Proc 2008; 40:2446-8. [DOI: 10.1016/j.transproceed.2008.06.015] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Areia A, Galvão A, Pais MSJ, Freitas L, Moura P. Outcome of pregnancy in renal allograft recipients. Arch Gynecol Obstet 2008; 279:273-7. [DOI: 10.1007/s00404-008-0711-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2008] [Accepted: 06/03/2008] [Indexed: 11/28/2022]
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Bolignano D, Coppolino G, Crascì E, Campo S, Aloisi C, Buemi M. Pregnancy in uremic patients: An eventful journey. J Obstet Gynaecol Res 2008; 34:137-43. [DOI: 10.1111/j.1447-0756.2008.00751.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Ducarme G, Ceccaldi PF, Toupance O, Graesslin O, Rieu P, Gabriel R. Grossesse après transplantation rénale. Suivi obstétrical et retentissement sur le greffon rénal. ACTA ACUST UNITED AC 2006; 34:209-13. [PMID: 16513403 DOI: 10.1016/j.gyobfe.2005.12.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2005] [Accepted: 12/19/2005] [Indexed: 02/09/2023]
Abstract
OBJECTIVE The aim of this study is to give the results of our experience about pregnancies among the renal transplantation patients and to assess the impact of the pregnancy on renal graft function. PATIENTS AND METHODS Twenty pregnancies from 17 renal transplant recipients were analysed and long-term outcome of the renal graft was studied. We analysed the outcomes from clinical and biological data before, during and after pregnancy. RESULTS Mean patient age was 30.3+/-3.5 years and meantime between transplantation and the onset of pregnancy was 62.4+/-34.5 months. There was no significant difference between the biological data before and after pregnancy. We did not observe any acute rejection. The mean maternal complications were preeclampsia in 35%, low birth weight in 39%, prematurity in 45% and cesarean sections in 55%. There is no impact of the pregnancy on the renal graft during the follow-up (3 years). The follow-up revealed 2 cases of chronic rejection. DISCUSSION AND CONCLUSION A multi-disciplinary approach of pregnancy in renal recipients and an interval of 2 years after kidney transplantation are necessary. There are more complications during pregnancy without increased risks of graft lose.
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Affiliation(s)
- G Ducarme
- Service de gynécologie-obstétrique, AP-HP, CHU Jean-Verdier, avenue du 14-Juillet, 93143 Bondy cedex, France.
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