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Reitz A, Rouzaire M, Cahierc R, Pereira B, Lemal R, Garrouste C, Gallot D. [Obstetrical outcome of renal transplant patients followed in a type III maternity hospital. Retrospective study from 2000 to 2020]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2024; 52:391-397. [PMID: 38296107 DOI: 10.1016/j.gofs.2024.01.011] [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: 08/14/2023] [Revised: 01/18/2024] [Accepted: 01/21/2024] [Indexed: 02/16/2024]
Abstract
AIM To describe pregnancy outcome of kidney transplant patients till 1 year postpartum. METHODS This retrospective, monocentric study included 15 kidney transplant patients who presented 18 pregnancies, between January 2000 and January 2020. For each of them, we searched for possible obstetrical, fetal and renal complications and we evaluated renal function before, during and after pregnancy. RESULTS The live birth rate was 84% (16/19) with an average gestational age at delivery of 37 weeks of gestation. The rate of prematurity was 50% (8/16), gestational diabetes was 16.6% (3/18) and preeclampsia was 27.7% (5/18). Cesarean section was performed in 61.1% (11/18) of cases including, 81.8% (9/11) unplanned surgery. The average birth weight was 2635 grams and 37.5% (6/16) of the newborn were small for gestational age. All patients had stable renal function before conception of pregnancy. We noticed two acute graft rejection during pregnancy with only one resulting in graft loss. Four patients had a reduced graft function in 12months of the postpartum. CONCLUSION Risk of maternal, fetal and renal complications remained high in kidney transplant recipients. Pregnancy should be carefully planned in transplanted women associated with adequate follow-up according to clinical guidelines (normal renal function and blood pressure without proteinuria before pregnancy, no recent graft rejection, period of one year after transplant respected and no teratogenic treatment in the month before pregnancy).
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Affiliation(s)
- Aurélie Reitz
- Service d'obstétrique, CHU de Clermont-Ferrand - Site Estaing, 1, place Lucie-et-Raymond-Aubrac, 63003 Clermont-Ferrand cedex 1, France
| | - Marion Rouzaire
- CIC 1405 unité CRECHE, Inserm, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France
| | - Romain Cahierc
- Service d'obstétrique, CHU de Clermont-Ferrand - Site Estaing, 1, place Lucie-et-Raymond-Aubrac, 63003 Clermont-Ferrand cedex 1, France
| | - Bruno Pereira
- Unité de biostatistiques, DRCI, CHU de Clermont-Ferrand, 58, rue Montalembert, 63000 Clermont-Ferrand cedex, France
| | - Richard Lemal
- Service d'hématologie clinique, CHU de Clermont-Ferrand - Site Gabriel-Montpied, 58, rue Montalembert, 63000 Clermont-Ferrand cedex 1, France
| | - Cyril Garrouste
- Service de néphrologie, CHU de Clermont-Ferrand - Site Gabriel-Montpied, 58, rue Montalembert, 63000 Clermont-Ferrand cedex 1, France
| | - Denis Gallot
- Service d'obstétrique, CHU de Clermont-Ferrand - Site Estaing, 1, place Lucie-et-Raymond-Aubrac, 63003 Clermont-Ferrand cedex 1, France; CIC 1405 unité CRECHE, Inserm, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France; CNRS UMR 6293, Inserm U1103, GReD, université Clermont Auvergne, 63000 Clermont-Ferrand, France.
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2
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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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3
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Sousa MVD, Guida JPDS, Surita FGDC, Parpinelli MA, Nascimento MLCD, Mazzali M. Twin pregnancy after kidney transplantation: case report and systematic review. ACTA ACUST UNITED AC 2021; 43:121-126. [PMID: 32672328 PMCID: PMC8061955 DOI: 10.1590/2175-8239-jbn-2020-0016] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 04/22/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Kidney transplantation is associated with fertility restoration in more than 50% of women with chronic kidney disease. Pregnancy after transplantation may affect women's health and fetal development, with higher rates of abortion, fetal growth restriction, and neonatal deaths. Twin pregnancy is a condition of high-risk for adverse maternal and perinatal outcomes, and its occurrence in women with previous kidney transplantation is rare. CASE 32-year-old woman, recipient of living donor kidney transplantation, with a history of one pregnancy prior to transplantation, with current normal allograft function and no use of contraceptive method. At ten weeks of amenorrhea, ultrasound investigation showed a dichorionic diamniotic twin pregnancy. The following evaluation showed Chiari type II features in one fetus, and no detectable abnormality in the other one. There was appropriate blood pressure control with no need for an antihypertensive drug, and renal function remained normal without proteinuria. Calcium and a low dose of acetylsalicylic acid were used as preeclampsia prophylaxis. At 33 weeks of gestation, she presented premature rupture of membranes with spontaneous preterm labor. A cesarean section was performed due to the breech presentation of the first fetus. The patient persisted with normal graft function and without graft rejection during follow-up. DISCUSSION AND CONCLUSION Twin pregnancies after kidney transplantation are rare, and it is most frequently associated with preterm birth. We reported a successful twin pregnancy after kidney transplantation, with good perinatal and maternal outcomes, and without graft rejection or dysfunction.
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Affiliation(s)
- Marcos Vinicius de Sousa
- Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Departamento de Clínica Médica, Divisão de Nefrologia, Unidade de Transplante Renal, Laboratório de Investigação em Transplante, Campinas, SP, Brasil
| | - José Paulo de Siqueira Guida
- Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Departamento de Tocoginecologia, Campinas, SP, Brasil
| | | | - Mary Angela Parpinelli
- Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Departamento de Tocoginecologia, Campinas, SP, Brasil
| | | | - Marilda Mazzali
- Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Departamento de Clínica Médica, Divisão de Nefrologia, Unidade de Transplante Renal, Laboratório de Investigação em Transplante, Campinas, SP, Brasil
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4
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Boulay H, Mazaud-Guittot S, Supervielle J, Chemouny JM, Dardier V, Lacroix A, Dion L, Vigneau C. Maternal, foetal and child consequences of immunosuppressive drugs during pregnancy in women with organ transplant: a review. Clin Kidney J 2021; 14:1871-1878. [PMID: 34345409 PMCID: PMC8323135 DOI: 10.1093/ckj/sfab049] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 03/01/2021] [Indexed: 02/06/2023] Open
Abstract
Although pregnancy remains exceptional in women after heart, liver or lung transplant, obstetricians and nephrologists are regularly confronted with pregnancy in renal transplant recipients. National and international registries have described the epidemiology of maternal, foetal and neonatal complications, and transplantation societies have published recommendations on the monitoring of these high-risk pregnancies. In this review, we summarize the existing data on maternal and foetal complications of pregnancies in women after renal transplant, especially the management of immunosuppression. We also describe the few available data on the middle- and long-term outcomes of their children who were exposed in utero to immunosuppressive drugs.
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Affiliation(s)
- Hugoline Boulay
- University of Rennes, CHU Rennes, INSERM, EHESP, IRSET (Institut de recherche en santé, environnement et travail) - UMR_S 1085, F-35000, Rennes, France
| | - Séverine Mazaud-Guittot
- University of Rennes, CHU Rennes, INSERM, EHESP, IRSET (Institut de recherche en santé, environnement et travail) - UMR_S 1085, F-35000, Rennes, France
| | - Jeanne Supervielle
- University of Rennes, CHU Rennes, INSERM, EHESP, IRSET (Institut de recherche en santé, environnement et travail) - UMR_S 1085, F-35000, Rennes, France
| | - Jonathan M Chemouny
- University of Rennes, CHU Rennes, INSERM, EHESP, IRSET (Institut de recherche en santé, environnement et travail) - UMR_S 1085, F-35000, Rennes, France
| | - Virginie Dardier
- Laboratoire de psychologie, comportement, cognition et communication (LP3 C), Université Rennes-Rennes 2, Rennes, France
| | - Agnes Lacroix
- Laboratoire de psychologie, comportement, cognition et communication (LP3 C), Université Rennes-Rennes 2, Rennes, France
| | - Ludivine Dion
- University of Rennes, CHU Rennes, INSERM, EHESP, IRSET (Institut de recherche en santé, environnement et travail) - UMR_S 1085, F-35000, Rennes, France
| | - Cécile Vigneau
- University of Rennes, CHU Rennes, INSERM, EHESP, IRSET (Institut de recherche en santé, environnement et travail) - UMR_S 1085, F-35000, Rennes, France
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5
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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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Dębska-Ślizień A, Gałgowska J, Bułło-Piontecka B, Bzoma B, Chamienia A, Król E, Lichodziejewska-Niemierko M, Lizakowski S, Pankrac Z, Preis K, Renke M, Rutkowski P, Śledziński Z, Zdrojewski Z. Pregnancy After Kidney Transplantation With Maternal and Pediatric Outcomes: A Single-Center Experience. Transplant Proc 2020; 52:2430-2435. [PMID: 32444125 DOI: 10.1016/j.transproceed.2020.01.122] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Accepted: 01/26/2020] [Indexed: 10/24/2022]
Abstract
Outcomes of pregnancies after kidney transplantation were evaluated. Thirty-one pregnancies in 26 women were noted. The mean maternal age at pregnancy was 31 ± 5 years (range, 23-44 years). The interval between transplantation and conception was 54 ± 51 months (range, 7-213 months). The mean serum creatinine concentration before conception was 1.28 ± 0.4 mg/dL (range, 0.8-2.45 mg/dL), and mean estimated glomerular filtration rate (Chronic Kidney Disease Epidemiology Collaboration) was 62 ± 18 mL/min/1.73 m2 (range, 27-106 mL/min/1.73 m2). There were no maternal deaths. There was 1 case of suspected acute rejection after delivery. There was 1 case of graft loss during pregnancy. Maternal complications included edema (6/26), hypertension (7/26), increase of (2/26) or appearance of proteinuria (5/26), and preeclampsia (4/26). Mean creatinine increase during pregnancy was 0.02 mg/dL. Mean creatinine 1 year after pregnancy was 1.54 mg/dL (±0.8 mg/dL). There were 19 cesarean sections. Fetal outcomes included 25 live births, 4 abortions, and 2 stillbirths. Out of 25 live births, 22 children were considered healthy, 2 children had congenital defects, and there were 2 deaths at neonatal age. Mean pregnancy age was 35 ± 4 weeks (range, 24-40 weeks). The rate of premature deliveries was 15 of 25. Mean neonate birth weight was 2363 ± 1029 grams (range, 490-4100 grams). The rate of babies small for gestational age was 19%. During follow-up (range, 0.5-30 years) 5 of 26 patients lost grafts (between 3 and 15 years after pregnancy); most (20) of the children previously considered healthy had good long-term development. Our results confirm that risk of pregnancy in kidney transplant recipients can be accepted, and children considered healthy at delivery develop well.
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Affiliation(s)
- Alicja Dębska-Ślizień
- Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdańsk, Poland
| | - Joanna Gałgowska
- Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdańsk, Poland.
| | - Barbara Bułło-Piontecka
- Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdańsk, Poland
| | - Beata Bzoma
- Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdańsk, Poland
| | - Andrzej Chamienia
- Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdańsk, Poland
| | - Ewa Król
- Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdańsk, Poland
| | | | - Sławomir Lizakowski
- Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdańsk, Poland
| | - Zofia Pankrac
- Department of Obstetrics, Medical University of Gdańsk, Poland
| | - Krzysztof Preis
- Department of Obstetrics, Medical University of Gdańsk, Poland
| | - Marcin Renke
- Department of Occupational and Internal Medicine, Medical University of Gdańsk, Poland
| | - Przemysław Rutkowski
- Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdańsk, Poland
| | | | - Zbigniew Zdrojewski
- Department of Internal Medicine, Connective Tissue Diseases and Geriatrics, Medical University of Gdańsk, Poland
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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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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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9
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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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10
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Piccoli GB, Cabiddu G, Attini R, Gerbino M, Todeschini P, Perrino ML, Manzione AM, Piredda GB, Gnappi E, Caputo F, Montagnino G, Bellizzi V, Di Loreto P, Martino F, Montanaro D, Rossini M, Castellino S, Biolcati M, Fassio F, Loi V, Parisi S, Versino E, Pani A, Todros T. Pregnancy outcomes after kidney graft in Italy: are the changes over time the result of different therapies or of different policies? A nationwide survey (1978–2013). Nephrol Dial Transplant 2016; 31:1957-1965. [DOI: 10.1093/ndt/gfw232] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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11
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Yousif MEA, Bridson JM, Halawa A. Contraception After Kidney Transplantation, From Myth to Reality: A Comprehensive Review of the Current Evidence. EXP CLIN TRANSPLANT 2016; 14:252-8. [PMID: 27041141 DOI: 10.6002/ect.2015.0278] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
There is a misconception among transplant clinicians that contraception after a successful renal transplant is challenging. This is partly due to the complex nature of transplant patients, where immunosuppression and graft dysfunction create major concerns. In addition, good evidence regarding contraception and transplant is scarce, with most of the evidence extrapolated from observational and case-controlled studies, thus adding to the dilemma of treating these patients. In this review, we closely analyzed the different methods of contraception and critically evaluated the efficacy of the different options for contraception after kidney transplant. We conclude that contraception after renal transplant is successful with acceptable risk. A multidisciplinary team approach involving obstetricians and transplant clinicians to decide the appropriate timing for conception is recommended. Early counseling on contraception is important to reduce the risk of unplanned pregnancies, improve pregnancy outcomes, and reduce maternal complications in patients after kidney transplant. To ascertain appropriate advice on the method of contraception, individualizing the method of contraception according to a patient's individual risks and expectations is essential.
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Affiliation(s)
- Mohamed Elamin Awad Yousif
- From the Nephrology Unit, Ibn Sina Hospital, Khartoum, Sudan; and the Faculty of Health and Science, Institute of Learning and Teaching, University of Liverpool, Liverpool, UK
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