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Chung K, Yin O, Kallapur A, Bass L, Coscia L, Constantinescu S, Moritz M, Afshar Y. Emergent prelabor cesarean delivery in solid organ transplant recipients: associated risk factors and outcomes. Am J Obstet Gynecol MFM 2023; 5:100799. [PMID: 36368514 DOI: 10.1016/j.ajogmf.2022.100799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Revised: 10/19/2022] [Accepted: 11/03/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND Pregnancies after solid organ transplant are at a higher risk of antepartum admission and pregnancy complications including cesarean delivery. Emergent prelabor cesarean delivery is associated with increased maternal and neonatal morbidity in other high-risk populations, but its incidence and impact in transplant recipients is not well-understood. OBJECTIVE This study aimed to characterize the risk factors and outcomes of emergency prelabor cesarean delivery in kidney and liver transplant recipients. STUDY DESIGN This was a retrospective cohort study of all kidney and liver transplant recipients at >20 weeks gestation enrolled in the Transplant Pregnancy Registry International between 1976 and 2019. Participants admitted antepartum who required emergency prelabor cesarean delivery were compared with those admitted antepartum who underwent nonemergent birth. The primary outcomes were severe maternal morbidity and neonatal composite morbidity. Multivariable logistic regression was conducted for neonatal composite morbidity. RESULTS Of 1979 births, 181 pregnancies (188 neonates) with antepartum admission were included. 51 pregnancies (53 neonates, 28%) were delivered by emergent prelabor cesarean delivery compared with 130 pregnancies (135 neonates, 72%) admitted antepartum who subsequently did not require emergent delivery. The most common indication for emergent delivery was nonreassuring fetal heart tracing (44 pregnancies /51 emergent deliveries = 86%). Pregnant people who underwent emergent prelabor cesarean delivery were less likely to deliver at a transplant center (37.3% vs 41.5%; P=.04) and had increased rates of chronic hypertension (33.3% vs 16.2%; P=.02). There was no significant difference in severe maternal morbidity (3.9% vs 4.6%; P=.84), though there was an increase in surgical site infection in the emergent prelabor cesarean delivery cohort (3.9% vs 0%; P=.02). Among those with emergent prelabor cesarean delivery, there was a significant increase in neonatal composite morbidity (43.4% vs 19.3%; P<.001) with earlier gestational age at delivery (33.4 vs 34.7 weeks; P=.02), lower birthweight (1899 g vs 2321 g; P<.001), lower birthweight percentile (30.3% vs 40.6%; P=.03), increased neonatal intensive care unit admission (52.8% vs 35.6%; P=.03), and increased neonatal mortality (11.3% vs 1.5%; P=.002). After adjusting for year of conception, race, hypertensive disorders, and fetal malformations, there was a persistent increased risk of neonatal morbidity (adjusted odds ratio, 3.01; 95% confidence interval, 1.50-6.08; P=.002) associated with emergent prelabor cesarean delivery after transplant. CONCLUSION Almost one-third of kidney and liver transplant recipients admitted antepartum had an emergency prelabor cesarean delivery, and 63% of this cohort delivered outside of a transplant center. Pregnancies after transplantation should involve multidisciplinary transplant-obstetrics collaboration to ensure optimal antepartum disease management, especially for preexisting hypertension, to prevent and mitigate obstetrical and neonatal morbidity in the setting of emergent cesarean delivery.
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Affiliation(s)
- Kathleen Chung
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, David Geffen School of Medicine, University of California, Los Angeles, CA (Drs Chung, Yin, and Kallapur, Ms Bass, and Dr Afshar)
| | - Ophelia Yin
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, David Geffen School of Medicine, University of California, Los Angeles, CA (Drs Chung, Yin, and Kallapur, Ms Bass, and Dr Afshar)
| | - Aneesh Kallapur
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, David Geffen School of Medicine, University of California, Los Angeles, CA (Drs Chung, Yin, and Kallapur, Ms Bass, and Dr Afshar)
| | - Lauren Bass
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, David Geffen School of Medicine, University of California, Los Angeles, CA (Drs Chung, Yin, and Kallapur, Ms Bass, and Dr Afshar)
| | - Lisa Coscia
- Transplant Pregnancy Registry International, Gift of Life Institute, Philadelphia, PA (Ms Coscia and Drs Constantinescu and Moritz)
| | - Serban Constantinescu
- Transplant Pregnancy Registry International, Gift of Life Institute, Philadelphia, PA (Ms Coscia and Drs Constantinescu and Moritz); Section of Nephrology, Department of Medicine, Lewis Katz School of Medicine, Temple University, Philadelphia, PA (Dr Constantinescu)
| | - Michael Moritz
- Transplant Pregnancy Registry International, Gift of Life Institute, Philadelphia, PA (Ms Coscia and Drs Constantinescu and Moritz); Department of Surgery, Lehigh Valley Health Network, Allentown, PA (Dr Moritz); Department of Surgery, Morsani College of Medicine, Tampa, FL (Dr Moritz)
| | - Yalda Afshar
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, David Geffen School of Medicine, University of California, Los Angeles, CA (Drs Chung, Yin, and Kallapur, Ms Bass, and Dr Afshar).
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2
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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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3
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Tang J, Gulyani A, Hewawasam E, McDonald S, Clayton P, Webster AC, Kanellis J, Jesudason S. Pregnancy outcomes for simultaneous Pancreas-Kidney transplant recipients versus kidney transplant recipients. Clin Transplant 2020; 35:e14151. [PMID: 33179349 DOI: 10.1111/ctr.14151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 10/25/2020] [Accepted: 11/02/2020] [Indexed: 12/01/2022]
Abstract
Data about pregnancy outcomes for simultaneous pancreas-kidney transplant recipients (SPKR) are limited. We compared pregnancy outcomes in SPKR to Kidney Transplant Recipients (KTR) from 2001-17 using the Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry and the Australian and New Zealand Pancreas Islet Transplant Registry (ANZPITR). A total of 19 pregnancies to 15 SPKR mothers, and 348 pregnancies to 235 KTR mothers were reported. Maternal ages were similar (SPKR 33.9 ± 3.9 years; KTR 32.1 ± 4.8 years, p = .10); however, SPKR had a shorter transplant to first-pregnancy interval compared to KTR (SPKR 3.3 years, IQR (1.7, 4.1); KTR 5 years, IQR (2.6, 8.7), p = .02). Median difference in creatinine pre- and post-pregnancy was similar between the groups (KTR -3 µmol/L, IQR (-15, 6), SPKR -3 µmol/L, IQR (-11, 3), p = .86). Maternal, fetal and kidney transplant outcomes were similar despite higher rates of pre-existing peripheral vascular and coronary artery diseases in SPKR. Live birth rates (>20 weeks) were comparable (SPKR 93.8% vs. KTR 96.8%, p = .06). KTR with either type 1 or type 2 diabetes mellitus (24 births) had similar outcomes compared to SPKR. In this national cohort, pregnancy outcomes were similar between SPKR and KTR mothers; however, findings should be interpreted with caution due to small sample sizes.
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Affiliation(s)
- Joanne Tang
- Central and Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Aarti Gulyani
- Australia and New Zealand Dialysis and Transplant Registry (ANZDATA) and Australian and New Zealand Organ Donation Registry (ANZOD), South Australian Health & Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia
| | - Erandi Hewawasam
- Australia and New Zealand Dialysis and Transplant Registry (ANZDATA) and Australian and New Zealand Organ Donation Registry (ANZOD), South Australian Health & Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia.,Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Stephen McDonald
- Central and Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, South Australia, Australia.,Australia and New Zealand Dialysis and Transplant Registry (ANZDATA) and Australian and New Zealand Organ Donation Registry (ANZOD), South Australian Health & Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia.,Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Phil Clayton
- Central and Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, South Australia, Australia.,Australia and New Zealand Dialysis and Transplant Registry (ANZDATA) and Australian and New Zealand Organ Donation Registry (ANZOD), South Australian Health & Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia.,Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Angela C Webster
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia.,Centre for Transplant and Renal Research, Westmead Hospital, Westmead, New South Wales, Australia
| | - John Kanellis
- Department of Nephrology, Monash Health and Centre for Inflammatory Diseases, Clayton, Victoria, Australia.,Department of Medicine, Monash University, Clayton, Victoria, Australia
| | - Shilpanjali Jesudason
- Central and Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, South Australia, Australia.,Australia and New Zealand Dialysis and Transplant Registry (ANZDATA) and Australian and New Zealand Organ Donation Registry (ANZOD), South Australian Health & Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia
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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, Christianson AL, Verma P, Meganathan K, Leonard AC, Schauer DP, Thakar CV. Racial disparities and factors associated with pregnancy in kidney transplant recipients in the United States. PLoS One 2019; 14:e0220916. [PMID: 31398243 PMCID: PMC6688836 DOI: 10.1371/journal.pone.0220916] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 07/25/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Although kidney transplant improves reproductive function in women with end-stage kidney disease (ESKD), pregnancy in kidney transplant recipients' remains challenging due to the risk of adverse maternal and fetal outcomes. METHODS We evaluated a retrospective cohort of 7,966 women who were aged 15-45 years and received a kidney transplant between January 1, 2005 and December 31, 2011 from the United States Renal Data System with Medicare as the primary payer for the entire three years after the date of transplantation. Unadjusted and adjusted rates of pregnancy in the first three post-transplant years were calculated, using Poisson regression for the adjustment. Factors associated with pregnancy, including race, were examined using logistic regression. RESULTS Overall, 293 pregnancies were identified in 7966 women. The unadjusted pregnancy rate was 13.8 per thousand person-years (PTPY) (95% confidence interval (CI), 12.3-15.5). Pregnancy rates were roughly constant in the years 2005-2011 except in 2005 and 2010. The rate of pregnancy was highest in Hispanic women (21.4 PTPY; 95% CI, 17.2-26.4) and Hispanic women had a higher likelihood of pregnancy as compared to white women (OR, 1.56; CI, 1.12-2.16). Pregnancy rates were lowest in women aged 30-34 years and 35-45 years at transplant, and women aged 30-34 years and 35-45 years at transplant were less likely to ever become pregnant during the follow-up (odds ratio [OR], 0.69; CI, 0.49-0.98 and OR, 0.14; CI 0.09-0.21 respectively) as compared to women aged 25-29 years at time of transplant. Women had higher rates of pregnancy in the second and third-year post-transplant (16.0 PTPY, CI 13.2-19.2 and 16.9 PTPY, CI 14.0-20.4) than in the first-year post-transplant (9.0 PTPY, CI 7.0-11.4). In transplant recipients, pregnancy was more likely in women with ESKD due to cystic disease (OR, 2.42; CI, 1.02-5.74) or glomerulonephritis (OR, 2.14; CI, 1.07-4.31) as compared to women with ESKD due to diabetes. CONCLUSION Hispanic race, younger age, and ESKD cause due to cystic disease or glomerulonephritis are significant factors associated with a higher likelihood of pregnancy. Pregnancy rates have been fairly constant over the last decade. This study improves our understanding of factors associated with pregnancy in kidney transplant recipients.
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Affiliation(s)
- Silvi Shah
- Division of Nephrology Kidney C.A.R.E. Program, University of Cincinnati, Cincinnati, Ohio, United States
| | - Annette L. Christianson
- Department of Biomedical Informatics, University of Cincinnati, Cincinnati, Ohio, United States
| | - Prasoon Verma
- Division of Neonatology, Cincinnati Children’s Hospital and Medical Center, Cincinnati, Ohio, United States
| | - Karthikeyan Meganathan
- Department of Biomedical Informatics, University of Cincinnati, Cincinnati, Ohio, United States
| | - Anthony C. Leonard
- Department of Family and Community Medicine, University of Cincinnati, Cincinnati, Ohio, United States
| | - Daniel P. Schauer
- Department of Internal Medicine, University of Cincinnati, Cincinnati, Ohio, United States
| | - Charuhas V. Thakar
- Division of Nephrology Kidney C.A.R.E. Program, University of Cincinnati, Cincinnati, Ohio, United States
- Division of Nephrology, VA Medical Center, Cincinnati, Ohio, United States
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6
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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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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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8
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Rao NN, Wilkinson C, Morton M, Bennett GD, Russ GR, Coates PT, Jesudason S. Successful pregnancy in a recipient of an ABO-incompatible renal allograft. Obstet Med 2018; 12:42-44. [PMID: 30891092 DOI: 10.1177/1753495x17745390] [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: 09/02/2016] [Accepted: 09/23/2017] [Indexed: 12/26/2022] Open
Abstract
Kidney transplantation restores fertility in patients with end-stage renal disease, with many successful pregnancies after kidney transplantation being reported. However, there are little data regarding pregnancy in women transplanted under modern-era desensitisation protocols that utilise rituximab, plasma exchange and intravenous immunoglobulin, including ABO-incompatible transplants. Pregnancies in ABO-incompatible recipients can pose new challenges from an immunological perspective. Here, we report a case of successful pregnancy using in vitro fertilisation, in a renal transplant recipient who underwent desensitisation two years prior, that included use of rituximab and plasma exchange to receive an ABO-incompatible transplant from her husband and subsequent father of the baby. We believe this was the first case of successful pregnancy after ABO-incompatible kidney transplantation in Australia and New Zealand. This case also highlights the difficulties faced in conception following transplantation and demonstrates that in vitro fertilisation utilising ovulation induction can be successfully utilised for conception in this cohort. This recipient also had gestational diabetes, worsening renal function and preterm delivery which are important complications often seen in pregnancies of solid organ transplant recipients.
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Affiliation(s)
- Nitesh N Rao
- Central and Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, SA, Australia.,School of Medicine, University of Adelaide, Adelaide, SA, Australia
| | - Chris Wilkinson
- Maternal-Fetal Medicine Unit, Women's and Children's Hospital, North Adelaide, SA, Australia
| | - Mark Morton
- Maternal-Fetal Medicine Unit, Women's and Children's Hospital, North Adelaide, SA, Australia
| | - Greg D Bennett
- Australian Red Cross Blood Service, Adelaide, SA, Australia
| | - Graeme R Russ
- Central and Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Patrick T Coates
- Central and Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, SA, Australia.,School of Medicine, University of Adelaide, Adelaide, SA, Australia
| | - Shilpa Jesudason
- Central and Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, SA, Australia.,School of Medicine, University of Adelaide, Adelaide, SA, Australia
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Li YP, Shih JC, Lin SY, Lee CN. Pregnancy outcomes after kidney transplantation-A single-center experience in Taiwan. Taiwan J Obstet Gynecol 2017; 55:314-8. [PMID: 27343307 DOI: 10.1016/j.tjog.2016.04.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/11/2014] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE This study investigated the pregnancy outcomes of women who had undergone kidney transplantations from 1992 to 2013 in a single medical center. MATERIALS AND METHODS Records for patients who had undergone kidney transplantations between 1992 and 2013 at National Taiwan University Hospital, Taipei, Taiwan were retrospectively reviewed, and data on obstetric conditions, neonatal outcomes, and maternal and neonatal complications were collected. RESULTS Data for a total of 15 pregnancies in 13 women who had undergone kidney transplantation between 1992 and 2013 were included in this study. The live birth rate was 87%. The mean gestational age was 35.4 ± 3.2 weeks, and the mean birth body weight was 2208.8 ± 678.8 g. Forty percent of the neonates were small for their gestational age (< 10(th) percentile); 53.3% of the pregnancies resulted in preterm deliveries (< 37 weeks); and 26.7% of the neonates needed Neonatal Intensive Care Unit admission. The prevalence rates of preeclampsia and gestational diabetes were 23.0% and 13.3%, respectively. CONCLUSION The pregnancy outcomes after kidney transplantation were favorable and the mean birth body weight was 2208.8 ± 678.8 g at 35.4 ± 3.2 weeks gestational age. However, the maternal and neonatal complication rates were still high, such as preterm labor, preeclampsia, and small for gestational age.
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Affiliation(s)
- Yi-Ping Li
- Department of Obstetrics and Gynecology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Jin-Chung Shih
- Department of Obstetrics and Gynecology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Shin-Yu Lin
- Department of Obstetrics and Gynecology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
| | - Chien-Nan Lee
- Department of Obstetrics and Gynecology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
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10
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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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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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Erman Akar M, Ozekinci M, Sanhal C, Kececioglu N, Mendilcioglu I, Senol Y, Dirican K, Kocak H, Dinckan A, Suleymanlar G. A Retrospective Analysis of Pregnancy Outcomes after Kidney Transplantation in a Single Center. Gynecol Obstet Invest 2014; 79:13-8. [DOI: 10.1159/000365815] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Accepted: 07/09/2014] [Indexed: 11/19/2022]
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13
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Xu L, Han P, Liu Y, Wang H, Yang Y, Qiu F, Peng W, Tang L, Fu J, Zhu X, Zhu Y. Study on the effect of kidney transplantation on the health of the patients' offspring: a report on 252 Chinese children. Cell Biochem Biophys 2014; 68:173-9. [PMID: 23733673 DOI: 10.1007/s12013-013-9685-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Even though the incidence of pregnancies in the female recipients is lower and also chronic renal disease in male patients is associated with impaired spermatogenesis, the health of the children born to these patients was not studied. In this report, we discuss information on the growth and development of offspring of 248 male and female kidney recipient patients. Physical and routine clinical measurements of the 252 offspring (129 male and 123 female) born to these transplantation patients were made along with the intelligence tests. In some of these children chest X-ray and immune indices were assessed. Among the recipients, 219 males fathered 223 children with an average birth weight of 3,255 ± 374 g and 29 female recipients gave birth to 29 children with an average birth weight of 2,923 ± 551. While most of these children were normal, we noticed a case of soft double toe, a case of short tongue tie, five cases of marginal mental retardation, three cases of proteinuria, six cases of microscopic hematuria, 15 cases of low hemoglobin, and 21 cases with recurrent respiratory tract infections. We conclude that kidney transplantation has no significant impact on the growth, development, health, and intelligence of the offspring born to recipients.
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Affiliation(s)
- Longgen Xu
- Kidney Transplant Center, Jiulisong Hospital, Hangzhou, 310013, China,
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14
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Arab K, Oddy L, Patenaude V, Abenhaim HA. Obstetrical and neonatal outcomes in renal transplant recipients. J Matern Fetal Neonatal Med 2014; 28:162-7. [DOI: 10.3109/14767058.2014.909804] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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15
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Clinical pregnancy after uterus transplantation. Fertil Steril 2013; 100:1358-63. [PMID: 23830110 DOI: 10.1016/j.fertnstert.2013.06.027] [Citation(s) in RCA: 136] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2013] [Revised: 06/13/2013] [Accepted: 06/14/2013] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To present the first clinical pregnancy after uterus transplantation. DESIGN Case study. SETTING Tertiary center. PATIENT(S) A 23-year-old Mayer-Rokitansky-Kuster-Hauser syndrome patient with previous vaginal reconstruction and uterus transplantation. INTERVENTION(S) Eighteen months after the transplant, the endometrium was prepared for transfer of the thawed embryos. MAIN OUTCOME MEASURE(S) Implantation of embryo in an allografted human uterus. RESULT(S) The first ET cycle with one day 3 thawed embryo resulted in a biochemical pregnancy. The second ET cycle resulted in a clinical pregnancy confirmed with transvaginal ultrasound visualization of an intrauterine gestational sac with decidualization. CONCLUSION(S) We have presented the first clinical pregnancy in a patient with absolute uterine infertility after uterus allotransplantation. Although the real success is the delivery of a healthy near-term baby, this clinical pregnancy is a great step forward and a proof of concept that the implantation phase works.
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Richman K, Gohh R. Pregnancy after renal transplantation: a review of registry and single-center practices and outcomes. Nephrol Dial Transplant 2012; 27:3428-34. [PMID: 22815546 DOI: 10.1093/ndt/gfs276] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Registries from North America, Australia and Europe are rich sources of clinical data on pregnancy after kidney transplantation. Single-center reports of pregnancy outcomes are limited by small sample sizes but not by the potential reporting bias that can impact registry data. Despite the differences in data pools, the obstetric and graft outcomes reported by single centers and registries have been similar. The majority of pregnancies are successful in renal transplant patients, but the risk of complications like pre-eclampsia, low birth weight and premature birth is high. Pregnancy has no significant impact on graft function or survival when baseline function is normal.
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Perales-Puchalt A, Vila Vives JM, López Montes J, Diago Almela VJ, Perales A. Pregnancy outcomes after kidney transplantation-immunosuppressive therapy comparison. J Matern Fetal Neonatal Med 2011; 25:1363-6. [DOI: 10.3109/14767058.2011.634461] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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18
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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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Cornella C, Riboni F, Praticò L, Conca R, Fenoglio R, Lazzarich E, Surico N, Paternoster D. Pregnancy and Renal Transplantation: A Case Report of the Risk of Antibody Induction Against Partner Antigens. Transplant Proc 2009; 41:3964-6. [DOI: 10.1016/j.transproceed.2009.06.233] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2008] [Accepted: 06/19/2009] [Indexed: 10/20/2022]
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Abstract
Reproductive success is a common, expected outcome for male and female recipients of solid-organ transplants. Men can father children, and women can become pregnant and carry the fetus to delivery. There are, however, important maternal and fetal complications that need to be considered to provide optimal care to the mother and her infant. Although pregnancy is common after the transplantation of all solid organs, guidelines for optimal counseling and clinical management are limited. This review discusses information to help the physician counsel the kidney transplant recipient about risks of pregnancy for the mother and the fetus and provides information to help guide treatment of the pregnant transplant recipient.
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Affiliation(s)
- Dianne B McKay
- Department of Immunology, IMM-1, The Scripps Research Institute, 10550 North Torrey Pines Road, La Jolla, CA 92037, USA.
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