1
|
Galsone R, Vītiņa S, Jansone M, Staka A, Mohammadian R. Successful full-term pregnancy after preterm event in a liver transplant patient: a case report. J Med Case Rep 2023; 17:506. [PMID: 38071338 PMCID: PMC10710722 DOI: 10.1186/s13256-023-04189-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 09/25/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Pregnancy after liver transplantation poses a significant challenge to both the patient and the transplant team. CASE PRESENTATION We present the case of a 19-year-old European patient who underwent liver transplantation 5 years previously owing to autoimmune hepatitis. Poor compliance with immunosuppressive therapy and missed follow-up visits during the patient's first pregnancy likely contributed to her liver function deterioration, hospitalization, and failed pregnancy. Owing to the patient's complex medical history, combined immunosuppressive treatment, and risks to the fetus, her second pregnancy was high risk. However, close outpatient monitoring and adherence to treatment led to a successful, uneventful, full-term pregnancy and healthy delivery. CONCLUSION Liver transplant recipients who desire to become pregnant require careful planning and management to ensure optimal outcomes for both the mother and the fetus. A personalized strategy is necessary to balance the potential benefits of childbirth with the risks involved in pregnancy after liver transplantation.
Collapse
Affiliation(s)
- Ramona Galsone
- Women and child health clinic, Pauls Stradins Clinical University Hospital, University of Latvia, Pilsonu street 13, Riga, 1002, Latvia
| | - Sandra Vītiņa
- Women and child health clinic, Pauls Stradins Clinical University Hospital, University of Latvia, Pilsonu street 13, Riga, 1002, Latvia
| | - Maira Jansone
- Women and child health clinic, Pauls Stradins Clinical University Hospital, University of Latvia, Pilsonu street 13, Riga, 1002, Latvia
| | - Aiga Staka
- Gastroenterology, Hepatology and Nutrition Therapy Center, Pauls Stradins Clinical University Hospital, Pilsonu street 13, Riga, 1002, Latvia
| | - Reza Mohammadian
- Radiology Department, Riga East University Clinical Hospital, Stradins University, Hippocrates Street 2, Riga, 1038, Latvia.
| |
Collapse
|
2
|
Özbilgin M, Egeli T, Ağalar C, Özkardeşler S, Saatli B, Ellidokuz H, Akarsu M, Ünek T, Karademir S, Astarcıoğlu İ. Evaluation of the Effects of Immunosuppressive Drugs Following Liver Transplantation on Pregnancy Outcomes: A Retrospective Study. Transplant Proc 2023:S0041-1345(23)00272-5. [PMID: 37230900 DOI: 10.1016/j.transproceed.2023.04.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 04/05/2023] [Accepted: 04/14/2023] [Indexed: 05/27/2023]
Abstract
BACKGROUND Liver transplantations can be safely performed in women of reproductive age. Women with chronic liver disease may have infertility for various reasons, although fertility returns after recovering >90% of sexual disorders following liver transplantation. The present study examined the effects of immunosuppressive drugs used by women of reproductive age undergoing liver transplantation in our clinic on pregnancy and pregnancy outcomes and evaluated mortality and morbidity in this patient population. METHODS Among the patients undergoing liver transplantation in our clinic between 1997 and 2020, those conceiving after liver transplantation were evaluated in the present study. Demographic data on maternal and newborn health, as well as mortality and morbidity, were recorded. Maternal transplant indications, graft type, the interval between transplantation and pregnancy, maternal age at pregnancy and the number of pregnancies, the number of living children, complications, delivery mode, immunosuppressive drugs, and blood levels were investigated. RESULTS A total of 615 liver transplantations (353 from a living donor, 262 from a cadaveric donor) were performed in our clinic. Furthermore, 33 pregnancies occurred in 22 women following transplantation (17 living donor liver transplantations, 5 deceased donor liver transplantations), and the data of these patients were recorded. Tacrolimus and mycophenolate mofetil were used as immunosuppressive therapy. CONCLUSIONS Liver transplantations can be safely performed in women of reproductive age if indicated, and these patients can be safely followed up throughout the pregnancy and during labor by a multidisciplinary team.
Collapse
Affiliation(s)
- Mücahit Özbilgin
- Department of General Surgery, Hepatobiliary Surgery and Liver Transplantation Unit, Dokuz Eylül University Hospital, Izmir, Turkey.
| | - Tufan Egeli
- Department of General Surgery, Hepatobiliary Surgery and Liver Transplantation Unit, Dokuz Eylül University Hospital, Izmir, Turkey
| | - Cihan Ağalar
- Department of General Surgery, Hepatobiliary Surgery and Liver Transplantation Unit, Dokuz Eylül University Hospital, Izmir, Turkey
| | - Sevda Özkardeşler
- Department of Anesthesiology and Reanimation, Dokuz Eylül University Hospital, Izmir, Turkey
| | - Bahadır Saatli
- Department of Gynecology and Obstetrics, Dokuz Eylül University Hospital, Izmir, Turkey
| | - Hülya Ellidokuz
- Department of Preventive Oncology, Dokuz Eylül University Hospital, Izmir, Turkey
| | | | - Tarkan Ünek
- Department of General Surgery, Hepatobiliary Surgery and Liver Transplantation Unit, Dokuz Eylül University Hospital, Izmir, Turkey
| | | | | |
Collapse
|
3
|
Rashidi-Alavijeh J, Frey A, Hörster A, Nguyen BP, Iannaccone A, Saner F, Lange CM, Willuweit K. Safe for Mother, Baby, and Graft? Pregnancy After Liver Transplant: A Single-Center Experience. Transplant Proc 2022; 54:744-748. [DOI: 10.1016/j.transproceed.2022.01.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 01/17/2022] [Indexed: 11/30/2022]
|
4
|
Usage of Tacrolimus and Mycophenolic Acid During Conception, Pregnancy, and Lactation, and Its Implications for Therapeutic Drug Monitoring: A Systematic Critical Review. Ther Drug Monit 2021; 42:518-531. [PMID: 32398419 DOI: 10.1097/ftd.0000000000000769] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Conception, pregnancy, and lactation following solid organ transplantation require appropriate management. The most frequently used immunosuppressive drug combination after solid organ transplantation consists of tacrolimus (Tac) plus mycophenolic acid (MPA). Here, the effects of Tac and MPA on fertility, pregnancy, and lactation are systematically reviewed, and their implications for therapeutic drug monitoring (TDM) are discussed. METHODS A systematic literature search was performed (August 19, 2019) using Ovid MEDLINE, EMBASE, the Cochrane Central Register of controlled trials, Google Scholar, and Web of Science, and 102 studies were included. Another 60 were included from the reference list of the published articles. RESULTS As MPA is teratogenic, women who are trying to conceive are strongly recommended to switch from MPA to azathioprine. MPA treatment in men during conception seems to have no adverse effect on pregnancy outcomes. Nevertheless, in 2015, the drug label was updated with additional risk minimization measures in a pregnancy prevention program. Data on MPA pharmacokinetics during pregnancy and lactation are limited. Tac treatment during conception, pregnancy, and lactation seems to be safe in terms of the health of the mother, (unborn) child, and allograft. However, Tac may increase the risk of hypertension, preeclampsia, preterm birth, and low birth weight. Infants will ingest very small amounts of Tac via breast milk from mothers treated with Tac. However, no adverse outcomes have been reported in children exposed to Tac during lactation. During pregnancy, changes in Tac pharmacokinetics result in increased unbound to whole-blood Tac concentration ratio. To maintain Tac concentrations within the target range, increased Tac dose and intensified TDM may be required. However, it is unclear if dose adjustments during pregnancy are necessary, considering the higher concentration of (active) unbound Tac. CONCLUSIONS Tac treatment during conception, pregnancy and lactation seems to be relatively safe. Due to pharmacokinetic changes during pregnancy, a higher Tac dose might be indicated to maintain target concentrations. However, more evidence is needed to make recommendations on both Tac dose adjustments and alternative matrices than whole-blood for TDM of Tac during pregnancy. MPA treatment in men during conception seems to have no adverse effect on pregnancy outcomes, whereas MPA use in women during conception and pregnancy is strongly discouraged.
Collapse
|
5
|
Abstract
Chronic liver disease in pregnancy is rare. Historically, many chronic liver diseases were considered contraindications to pregnancy; however, with current monitoring and treatment strategies, pregnancy may be considered in many cases. Preconception and initial antepartum consultation should focus on disease activity, medication safety, risks of pregnancy, as well as the need for additional monitoring during pregnancy. In most cases, a multidisciplinary approach is necessary to ensure optimal maternal and fetal outcomes. Despite improving outcomes, pregnancy in women with the chronic liver disease remains high risk.
Collapse
|
6
|
D’AMBROSIO D, TAVANO D, LATTANZI B, FRAMARINO DEI MALATESTA M, DE VILLE DE GOYET J, CORSI A, MITTERHOFER AP, GINANNI CORRADINI S, MENNINI G, ROSSI M, MERLI M. Acute rejection on immune-mediated chronic rejection after liver transplantation. GAZZETTA MEDICA ITALIANA ARCHIVIO PER LE SCIENZE MEDICHE 2021. [DOI: 10.23736/s0393-3660.19.04240-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
7
|
Gülümser Ç, Kinap M, Yanik FB, Sahin Uysal N, Moray G, Haberal M. How safe is pregnancy after liver transplantation? A large case series study at tertiary referral center in Turkey. J Matern Fetal Neonatal Med 2018; 33:1218-1224. [DOI: 10.1080/14767058.2018.1517317] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Çağrι Gülümser
- Department of Obstetrics and Gynecology, University of Health Sciences, Ankara, Turkey
| | - Mahir Kinap
- Department of General Surgery, Baskent University School of Medicine, Baskent, Turkey
| | | | - Nihal Sahin Uysal
- Department of Obstetrics and Gynecology, University of Health Sciences, Ankara, Turkey
| | - Gokhan Moray
- Department of General Surgery, Baskent University School of Medicine, Baskent, Turkey
| | - Mehmet Haberal
- Department of General Surgery, Baskent University School of Medicine, Baskent, Turkey
| |
Collapse
|
8
|
Akarsu M, Unek T, Avcu A, Ozbilgin M, Egeli T, Astarcioglu I. Evaluation of Pregnancy Outcomes After Liver Transplantation. Transplant Proc 2016; 48:3373-3377. [DOI: 10.1016/j.transproceed.2016.09.033] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 09/28/2016] [Indexed: 12/27/2022]
|
9
|
Kanzaki Y, Kondoh E, Kawasaki K, Mogami H, Chigusa Y, Konishi I. Pregnancy outcomes in liver transplant recipients: A 15-year single-center experience. J Obstet Gynaecol Res 2016; 42:1476-1482. [DOI: 10.1111/jog.13096] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Revised: 04/29/2016] [Accepted: 06/11/2016] [Indexed: 12/01/2022]
Affiliation(s)
- Yu Kanzaki
- Department of Gynaecology and Obstetrics; Kyoto University; Kyoto Japan
| | - Eiji Kondoh
- Department of Gynaecology and Obstetrics; Kyoto University; Kyoto Japan
| | - Kaoru Kawasaki
- Department of Gynaecology and Obstetrics; Kyoto University; Kyoto Japan
| | - Haruta Mogami
- Department of Gynaecology and Obstetrics; Kyoto University; Kyoto Japan
| | | | - Ikuo Konishi
- Department of Gynaecology and Obstetrics; Kyoto University; Kyoto Japan
| |
Collapse
|
10
|
AISF position paper on liver transplantation and pregnancy: Women in Hepatology Group, Italian Association for the Study of the Liver (AISF). Dig Liver Dis 2016; 48:860-8. [PMID: 27267817 DOI: 10.1016/j.dld.2016.04.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Accepted: 04/11/2016] [Indexed: 12/11/2022]
Abstract
After the first successful pregnancy in a liver transplant recipient in 1978, much evidence has accumulated on the course, outcomes and management strategies of pregnancy following liver transplantation. Generally, liver transplantation restores sexual function and fertility as early as a few months after transplant. Considering that one third of all liver transplant recipients are women, that approximately one-third of them are of reproductive age (18-49 years), and that 15% of female liver transplant recipients are paediatric patients who have a >70% probability of reaching reproductive age, the issue of pregnancy after liver transplantation is rather relevant, and obstetricians, paediatricians, and transplant hepatologists ever more frequently encounter such patients. Pregnancy outcomes for both the mother and infant in liver transplant recipients are generally good, but there is an increased incidence of preterm delivery, hypertension/preeclampsia, foetal growth restriction, and gestational diabetes, which, by definition, render pregnancy in liver transplant recipients a high-risk one. In contrast, the risk of congenital anomalies and the live birth rate are comparable to those of the general population. Currently there are still no robust guidelines on the management of pregnancies after liver transplantation. The aim of this position paper is to review the available evidence on pregnancy in liver transplant recipients and to provide national Italian recommendations for clinicians caring for these patients.
Collapse
|
11
|
Madej A, Pietrzak B, Mazanowska N, Songin T, Kociszewska-Najman B, Cyganek A, Jabiry-Zieniewicz Z, Wielgos M. Hypertension in Pregnant Renal and Liver Transplant Recipients. Transplant Proc 2016; 48:1730-5. [DOI: 10.1016/j.transproceed.2016.01.041] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Accepted: 01/21/2016] [Indexed: 10/21/2022]
|
12
|
Rao S, Ghanta M, Moritz MJ, Constantinescu S. Long-Term Functional Recovery, Quality of Life, and Pregnancy After Solid Organ Transplantation. Med Clin North Am 2016; 100:613-29. [PMID: 27095649 DOI: 10.1016/j.mcna.2016.01.010] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
This article reviews the salient features of functional recovery, health-related quality of life (HR-QOL), and reproductive health, with special emphasis on pregnancy outcomes in kidney and liver recipients. Transplantation results in improved functional status and HR-QOL. Addressing factors that limit the optimal rehabilitation of transplant recipients can improve transplant outcomes. After successful transplantation, there is a rapid return of fertility, warranting counseling regarding contraception. Practitioners should be aware of the teratogenic potential of mycophenolic acid products. Posttransplant pregnancies are high risk, with increased incidences of hypertension, preeclampsia, and prematurity. Most pregnancies in kidney and liver recipients have successful maternal and newborn outcomes.
Collapse
Affiliation(s)
- Swati Rao
- Section of Nephrology, Hypertension and Kidney Transplantation, Temple University School of Medicine, 3440 North Broad Street, Kresge West, Suite 100, Philadelphia, PA 19140, USA
| | - Mythili Ghanta
- Pancreas Transplant Program, Section of Nephrology, Hypertension and Kidney Transplantation, Temple University School of Medicine, 3440 North Broad Street, Kresge West, Suite 100, Philadelphia, PA 19140, USA
| | - Michael J Moritz
- Transplant Services, Lehigh Valley Health Network, Allentown, PA 18103, USA; Morsani College of Medicine, University of South Florida, Tampa, FL 33612, USA; National Transplantation Pregnancy Registry, Gift of Life Institute, 401 North 3rd Street, Philadelphia, PA 19123, USA
| | - Serban Constantinescu
- National Transplantation Pregnancy Registry, Gift of Life Institute, 401 North 3rd Street, Philadelphia, PA 19123, USA; Kidney Transplant Program, Section of Nephrology, Hypertension and Kidney Transplantation, Temple University School of Medicine, 3440 North Broad Street, Kresge West, Suite 100, Philadelphia, PA 19140, USA.
| |
Collapse
|
13
|
Westbrook RH, Yeoman AD, Agarwal K, Aluvihare V, O'Grady J, Heaton N, Penna L, Heneghan MA. Outcomes of pregnancy following liver transplantation: The King's College Hospital experience. Liver Transpl 2015; 21:1153-9. [PMID: 26013178 DOI: 10.1002/lt.24182] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2015] [Revised: 04/21/2015] [Accepted: 04/26/2015] [Indexed: 12/13/2022]
Abstract
Reports of pregnancy in liver transplantation (LT) patients have largely favorable outcomes. Concerns remain with regards to maternal and graft risk, optimal immunosuppression (IS), and fetal outcomes. We review all post-LT pregnancies at our center with regard to the outcomes and safety for the patient, graft, and fetus. A total of 117 conceptions occurred in 79 patients. Median age at conception was 29 years. Maternal complications included graft loss (2%), acute cellular rejection (ACR; 15%), pre-eclampsia/eclampsia (15%), gestational diabetes (7%), and bacterial sepsis (5%). ACR was significantly more common in those women who conceived within 12 months of LT (P = 0.001). The live birth rate was 73%. Prematurity occurred in 26 (31%) neonates, and 24 (29%) neonates were of low or very low birth weight. IS choice (cyclosporine versus tacrolimus) had no significant effect on pregnancy outcomes and complications. No congenital abnormalities occurred, and only 1 child born at 24 weeks had delayed developmental milestones. In conclusion, pregnancy following LT has a favorable outcome in the majority, but severe maternal risks remain. Patients should be counseled with regard to the above information so informed decisions can be made, and pregnancy must be considered high risk with regular monitoring by transplant clinicians and specialist obstetricians.
Collapse
Affiliation(s)
- Rachel H Westbrook
- Institute of Liver Studies, King's College Hospital, National Health Service Foundation Trust, London, United Kingdom
| | - Andrew D Yeoman
- Institute of Liver Studies, King's College Hospital, National Health Service Foundation Trust, London, United Kingdom
| | - Kosh Agarwal
- Institute of Liver Studies, King's College Hospital, National Health Service Foundation Trust, London, United Kingdom
| | - Varuna Aluvihare
- Institute of Liver Studies, King's College Hospital, National Health Service Foundation Trust, London, United Kingdom
| | - John O'Grady
- Institute of Liver Studies, King's College Hospital, National Health Service Foundation Trust, London, United Kingdom
| | - Nigel Heaton
- Institute of Liver Studies, King's College Hospital, National Health Service Foundation Trust, London, United Kingdom
| | - Leonie Penna
- Institute of Liver Studies, King's College Hospital, National Health Service Foundation Trust, London, United Kingdom
| | - Michael A Heneghan
- Institute of Liver Studies, King's College Hospital, National Health Service Foundation Trust, London, United Kingdom
| |
Collapse
|
14
|
Margioula-Siarkou C, Kalogiannidis I, Petousis S, Kubanangidi C, Fouzas I, Imvrios G, Papanikolaou V, Rousso D. Pregnancy after liver transplantation. How safe? A retrospective case-series study in a large tertiary hospital. J Matern Fetal Neonatal Med 2015; 29:2120-4. [DOI: 10.3109/14767058.2015.1076788] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
| | - Ioannis Kalogiannidis
- 3rd Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Thessaloniki, Greece and
| | - Stamatios Petousis
- 3rd Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Thessaloniki, Greece and
| | - Constantin Kubanangidi
- 3rd Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Thessaloniki, Greece and
- Organ Transplantation Unit, Hippokration General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ioannis Fouzas
- Organ Transplantation Unit, Hippokration General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Georgios Imvrios
- Organ Transplantation Unit, Hippokration General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Vasileios Papanikolaou
- Organ Transplantation Unit, Hippokration General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - David Rousso
- 3rd Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Thessaloniki, Greece and
| |
Collapse
|
15
|
Ramirez CB, Doria C. Pregnancy after liver transplantation. Best Pract Res Clin Obstet Gynaecol 2014; 28:1137-45. [DOI: 10.1016/j.bpobgyn.2014.07.022] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Accepted: 07/14/2014] [Indexed: 10/24/2022]
|
16
|
Abstract
OBJECTIVE To provide an approach to the care of liver transplant (LT) patients, a growing patient population with unique needs. METHODS A literature search of PubMed for guidelines and review articles using the keywords "liver transplantation", "long term complications" and "medical management" was conducted, resulting in 77 articles. RESULTS As a result of being on immunosuppression, LT recipients are at increased risk of infections and must be screened regularly for metabolic complications and malignancies. DISCUSSION Although immunosuppression is key to maintaining allograft health after transplantation, it comes with its own set of medical issues to follow. Physicians following LT recipients must be aware of the greater risk for hypertension, diabetes, dyslipidemia, renal failure, metabolic bone disease and malignancies in these patients, all of whom require regular monitoring and screening. Vaccination, quality of life, sexual function and pregnancy must be specifically addressed in transplant patients.
Collapse
|
17
|
Liver Transplantation during Pregnancy for Acute Liver Failure due to HBV Infection: A Case Report. Case Rep Obstet Gynecol 2013; 2013:356560. [PMID: 24383021 PMCID: PMC3872232 DOI: 10.1155/2013/356560] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2013] [Accepted: 10/28/2013] [Indexed: 12/31/2022] Open
Abstract
Acute hepatic failure during pregnancy is a life-threatening situation for the mother and fetus and might need a super-urgent liver transplantation. Many pregnancies with positive outcomes are reported after a previous liver transplantation before the pregnancy, but only a few of them are mentioned with transplantation during pregnancy. In these few cases, fetal outcome is mostly adverse. Experience with liver failure during pregnancy and its management is still deficient and needs to be approved. For sure, patients need to be treated in highly qualified centers in a multidisciplinary approach. We present a case of successful super-urgent liver transplantation during the second trimester of pregnancy after acute hepatic failure due to an acute hepatitis B infection with positive maternal and fetal outcome. Liver transplantation during pregnancy due to an acute liver failure can be a life-saving procedure for the mother and fetus. An early initiated maternal therapy with antiviral drugs and immunoglobulins seems to be safe and able to prevent fetal infection and immunosuppressive therapy after transplantation seems to be well tolerated. Nevertheless, fetal outcome differs widely and long-term outcome is deficiently known.
Collapse
|
18
|
Multidisciplinary management of a hepatic and renal transplant patient with Alagille syndrome. Int J Obstet Anesth 2012; 21:382-3. [PMID: 22959070 DOI: 10.1016/j.ijoa.2012.08.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2012] [Revised: 07/20/2012] [Accepted: 08/06/2012] [Indexed: 02/01/2023]
|
19
|
Abstract
Liver transplantation has become a universally accepted treatment for numerous congenital and acquired hepatic disorders that cause liver failure. Without liver transplantation, patients in their reproductive years are afflicted with oligospermia or azoospermia in men and amenorrhea in women, with infertility being a consequence in both sexes. The aim of this study is to describe our experiences concerning the parenthood of pediatric individuals who are successful recipients of liver transplantations coming into the reproductive years of life. We retrospectively analyzed data of 207 pediatric liver transplanted patients (96 women, 111 men). Among them, three women conceived and delivered four babies, and two men admitted to paternity of two children after they all had been recipients of liver transplants. All female transplant recipients had received tacrolimus-based immunosuppression. Preterm delivery was the most clinically important complication among these patients. Only one of the female patients experienced hypercalcemia during the pregnancy. None had any other complications such as hypertension, preeclampsia, cholestasis, or diabetes. There was no graft insufficiency, rejection, or birth defect. We concluded that maternity and paternity in liver transplant patients show normal outcomes even though this procedure occurs in childhood, and pregnancy did not seem to impair graft function in patients receiving immunosuppressive drugs.
Collapse
Affiliation(s)
- Çiğdem Ecevit
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Faculty of Medicine, Ege University, Izmir, Turkey.
| | | | | | | |
Collapse
|
20
|
Spearman CWN, Goddard E, McCulloch MI, Hairwadzi HN, Sonderup MW, Kahn D, Millar AJW. Pregnancy following liver transplantation during childhood and adolescence. Pediatr Transplant 2011; 15:712-7. [PMID: 22004545 DOI: 10.1111/j.1399-3046.2011.01554.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
More than 80% of pediatric transplant recipients will survive to reach adulthood, and many will consider having children. We report on outcomes and management of five pregnancies in four women undergoing orthotopic liver transplantation during childhood or adolescence and followed up at our Transplant Center. A retrospective clinical folder audit was performed. Mean age at transplantation was 13.3 ± 3.4 yr (range, 10-18 yr). Mean interval between transplantation and pregnancy was 15.4 ± 4.9 yr (range, 10-22 yr). Mean maternal age at conception was 28 ± 3.5 yr (range, 23-32 yr). Mean gestational age was 36.6 ± 1.7 wk. Mean birth weight was 2672 ± 249 g. Immunosuppression was cyclosporin based in three women and tacrolimus based in one woman. Pregnancy complications necessitating the induction of labor included fetal distress and rising maternal liver enzymes in two women, cholestasis of pregnancy and impaired renal graft function in one woman, fetal distress and preeclampsia in one woman. Modes of delivery were normal vaginal delivery in three women and cesarean section in one woman. No maternal or fetal deaths and no congenital malformations occurred. No episodes of rejection occurred during pregnancy. Two women experienced acute cellular rejection requiring an increase in baseline immunosuppression in the first year, following delivery. No graft losses occurred during a mean follow-up of 44 ± 17.9 months post-delivery. With careful management, pregnancy post-liver transplantation can have a successful outcome.
Collapse
Affiliation(s)
- C W N Spearman
- Red Cross War Memorial Children's Hospital, University of Cape Town Medical School, Cape Town, South Africa.
| | | | | | | | | | | | | |
Collapse
|
21
|
Costa MLB, Surita FGC, Passini R, Cecatti JG, Boin IFSF. Pregnancy outcome in female liver transplant recipients. Transplant Proc 2011; 43:1337-9. [PMID: 21620123 DOI: 10.1016/j.transproceed.2011.02.026] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
UNLABELLED Transplantation has become an available and successful treatment option for numerous congenital and acquired hepatic disorders. Studies have shown that when the prepregnancy recipient graft function is stable and adequate, pregnancy is normally well tolerated with favorable neonatal outcomes. However, there are reports of increased incidences of hypertension and preeclampsia as well as lower birth weights and prematurity. Patients administered tacrolimus-based therapies seem to have lower incidences of these complications. CASE REPORTS The 5 reported patients, aged 23–37 years at the time of conception, were 2–11 years posttransplantation. A preterm delivery for fetal distress was the most clinically important complication among these patients. One episode of acute genital herpes infection, 1 liver hematoma in a patient who was anticoagulated owing to a history of deep vein thrombosis, and 1 case of wound infection postpartum were also observed. Despite these complications, all 5 pregnancies were successful. The mean gestational age at delivery was 35.2 weeks. No structural malformations or early complications were observed in the neonates. All cases showed stable liver parameters.
Collapse
Affiliation(s)
- M L B Costa
- Department of Gynecology and Obstetrics, State University of Campinas, Campinas, Brazil
| | | | | | | | | |
Collapse
|
22
|
Abstract
This article briefly discusses gestational physiologic changes and thereafter reviews liver diseases during pregnancy, which are divided into 3 main categories. The first category includes conditions that are unique to pregnancy and generally resolve with the termination of pregnancy, the second category includes liver diseases that are not unique to the pregnant population but occur commonly or are severely affected by pregnancy, and the third category includes diseases that occur coincidentally with pregnancy and in patients with underlying chronic liver disease, with cirrhosis, or after liver transplant who become pregnant.
Collapse
Affiliation(s)
- Ayaz Matin
- Division of Gastroenterology and Hepatology, Drexel University College of Medicine, 12th Floor New College Building, 245 North 15th Street, Suite 12324, Philadelphia, PA 19102, USA
| | | |
Collapse
|
23
|
Revaux A, Bernuau J, Ceccaldi PF, Luton D, Ducarme G. [Liver transplantation and pregnancy]. Presse Med 2010; 39:1143-9. [PMID: 20965116 DOI: 10.1016/j.lpm.2010.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2010] [Revised: 04/27/2010] [Accepted: 05/02/2010] [Indexed: 02/07/2023] Open
Abstract
Patients with liver failure have menstrual cycle irregularities or amenorrhea. Liver transplantation restores menstrual pattern among women with cirrhosis in childbearing years. It is now accepted that a planned pregnancy is possible among liver transplant recipients at least 1 year after liver transplantation, with stable allograft function and under immunosuppressive regimens, to minimize the risks of preterm delivery and pregnancy-induced hypertension. After 1 year, the risk of graft loss decreases and is not related to pregnancy. It is a high-risk pregnancy which requires a specific and regular multidisciplinary joint follow-up (obstetrician, hepatologist, and anaesthesiologist), which leads in most cases to successful outcome for mother and child. But, early prevention and multidisciplinary management of the most common complications (pregnancy-induced hypertension, preeclampsia, and fetal growth restriction) is essential. The prematurity rate, maternal morbidity and mortality are higher than in the general population. Usual immunosuppressive treatments (corticoids, cyclosporine, tacrolimus, azathioprine or mycophenolate mofetil) may require dose adaptation during pregnancy. Immunosuppressive drugs are not teratogenic, but breast feeding is not allowed.
Collapse
Affiliation(s)
- Aurélie Revaux
- Université Paris VII, Assistance publique-Hôpitaux de Paris (AP-HP), hôpital Beaujon, service de gynécologie obstétrique, 92110 Clichy, France
| | | | | | | | | |
Collapse
|
24
|
Parolin MB, Coelho JCU, Urbanetz AA, Pampuch M. [Contraception and pregnancy after liver transplantation: an update overview]. ARQUIVOS DE GASTROENTEROLOGIA 2009; 46:154-8. [PMID: 19578619 DOI: 10.1590/s0004-28032009000200015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2008] [Accepted: 10/01/2008] [Indexed: 11/22/2022]
Abstract
CONTEXT Successful liver transplantation not only treats the underlying liver disease but also restores libido and fertility in female recipients. Although reports of successful pregnancy after liver transplantation continue to increase, these pregnancies are considered of high-risk because they are associated with increase maternofetal morbidity. EVIDENCE ACQUISITION A MEDLINE search (1978-2007) was conducted using the terms 'liver transplantation', 'pregnancy', 'immunosuppressive agents', 'sexual function'. Reviews, retrospective series, long-term clinical follow-up of case series and original articles containing basic scientific observations were included. RESULTS Although no formal guidelines have been established there are some 'golden rules' to improve the probability of favorable maternal and fetal outcome. Most transplant centers recommend to delay pregnancy for at least 1-year after transplantation. The recipient should be on a stable immunosuppression regimen, with good graft function and no evidence of renal dysfunction or uncontrolled arterial hypertension. Considering the increased incidence of prematurity, low birth weight, hypertension and preeclampsia reported during pregnancy post-LT, these high-risk patients should be managed by a multidisciplinary team, including an obstetrician specialized in high-risk pregnancies. Carefully monitoring of immunosuppressive drugs serum level is prudent to avoid graft rejection episodes and drugs with teratogenic potential should be discontinued. Breastfeeding is usually not recommended. CONCLUSIONS Successful pregnancies are the rule after liver transplantation. A carefully monitoring by an experience multidisciplinary team increases the chances of favorable maternofetal outcome.
Collapse
Affiliation(s)
- Mônica Beatriz Parolin
- Serviço de Transplante Hepático, Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, PR.
| | | | | | | |
Collapse
|
25
|
Jabiry-Zieniewicz Z, Kaminski P, Bobrowska K, Pietrzak B, Wielgos M, Smoter P, Zieniewicz K, Krawczyk M. Menstrual function in female liver transplant recipients of reproductive age. Transplant Proc 2009; 41:1735-9. [PMID: 19545718 DOI: 10.1016/j.transproceed.2009.03.073] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2007] [Revised: 11/04/2008] [Accepted: 03/11/2009] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND AIM End-stage liver failure is associated with severe abnormalities in menstrual and reproductive function. These abnormalities may be reversed by successful orthotopic liver transplantation (OLT). The aim of the study was to investigate menstrual patterns and sex hormone profiles among female liver transplant recipients of reproductive age. METHODS The study group consisted of 24 women of reproductive age with end-stage liver failure who underwent successful OLT. Menstrual patterns and sex hormone profiles were analyzed before as well as 3 and 12 months after OLT. Twenty-seven healthy women of reproductive age served as controls. Biochemical parameters of liver function were assessed before and after OLT. RESULTS Amenorrhea was the most commonly observed abnormality of menstrual cycle in women with end-stage liver failure (71% of patients). The recurrence of regular menstrual cycles was observed in 35% of patients 3 months after OLT. The percentage increased to 70% at 1 year after grafting and was clearly associated with stabilization of liver function. Similar levels of follicle stimulation hormone (FSH), luteinizing hormone (LH), prolactine (PRL), and testosterone (T) as well as lower levels of estradiol (E(2)), dehydroepiandrostendione sulphate (DHEA-S), and progesterone, (P) were observed in patients with liver failure compared with healthy women. We observed normalization of E(2) and DHEA-S levels after OLT. CONCLUSIONS Amenorrhea, the most common menstrual disturbance in women with end-stage liver failure, may be reversed by OLT. One year after OLT menstrual bleedings were noted in 74% of patients of reproductive age. The recurrence of reproductive function indicated the need for effective and safe family planning methods in that group of patients.
Collapse
Affiliation(s)
- Z Jabiry-Zieniewicz
- 1st Department of Obstetrics and Gynecology, The Medical University of Warsaw, Warsaw, Poland
| | | | | | | | | | | | | | | |
Collapse
|
26
|
McGuire BM, Rosenthal P, Brown CC, Busch AMH, Calcatera SM, Claria RS, Hunt NK, Korenblat KM, Mazariegos GV, Moonka D, Orloff SL, Perry DK, Rosen CB, Scott DL, Sudan DL. Long-term management of the liver transplant patient: recommendations for the primary care doctor. Am J Transplant 2009; 9:1988-2003. [PMID: 19563332 DOI: 10.1111/j.1600-6143.2009.02733.x] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
No official document has been published for primary care physicians regarding the management of liver transplant patients. With no official source of reference, primary care physicians often question their care of these patients. The following guidelines have been approved by the American Society of Transplantation and represent the position of the association. The data presented are based on formal review and analysis of published literature in the field and the clinical experience of the authors. These guidelines address drug interactions and side effects of immunosuppressive agents, allograft dysfunction, renal dysfunction, metabolic disorders, preventive medicine, malignancies, disability and productivity in the workforce, issues specific to pregnancy and sexual function, and pediatric patient concerns. These guidelines are intended to provide a bridge between transplant centers and primary care physicians in the long-term management of the liver transplant patient.
Collapse
Affiliation(s)
- B M McGuire
- University of Alabama at Birmingham, Birmingham, AL, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
27
|
Cannesson A, Boleslawski E, Declerck N, Mathurin P, Pruvot FR, Dharancy S. [Daily life, pregnancy, and quality of life after liver transplantation]. Presse Med 2009; 38:1319-24. [PMID: 19586750 DOI: 10.1016/j.lpm.2009.06.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2009] [Revised: 06/09/2009] [Accepted: 06/09/2009] [Indexed: 12/26/2022] Open
Abstract
It is now accepted that patients with a liver transplantation regain the ability to lead a normal life within months of surgery, but at the price of lifetime immunosuppressive treatment and specific regular surveillance. A balanced and diversified diet, together with regular physical activity is necessary to prevent, limit, or delay the development of the cardiovascular complications that determine the prognosis for long-term survival. Attenuated live vaccines are contraindicated in patients treated with immunosuppressants to avoid the risk of reversion of the attenuation of the virus or bacteria. Travel abroad is possible to places with good sanitary conditions, if the patient increases his or her vigilance for any contagious infection. The global incidence of cancer is higher than in the general population, justifying specific and regular testing and clinical monitoring. A planned pregnancy is possible in patients stabilized after liver transplantation, and prognosis is most often good for mother and child. Early multidisciplinary management is essential because of the elevated risks of fetal growth restriction and preterm delivery. The global perception of quality of life increases after liver transplantation, but remains lower than in healthy subjects.
Collapse
Affiliation(s)
- Amélie Cannesson
- Maladies de l'appareil digestif et de la nutrition, Pôle de médecine Huriez, Hôpital Huriez, CHRU Lille, Lille, France
| | | | | | | | | | | |
Collapse
|
28
|
Xia D, He HY, Xu L, Quan Y, Zuo HQ, Yan LN, Li B, Zeng Y, Pan GD. Pregnancy after liver transplantation: Four-year follow-up of the first case in mainland China. World J Gastroenterol 2008; 14:7264-6. [PMID: 19084946 PMCID: PMC2776889 DOI: 10.3748/wjg.14.7264] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
The safety and feasibility of pregnancy following liver transplantation (LT) have been accredited in a series of LT center. The first case in mainland China is reported. The follow-up data of a 22-year-old pregnant patient with end-stage liver disease undergone orthotopic liver transplantation were analyzed retrospectively. After surgery, the patient was uneventfully recovered and became pregnant 33 mo after LT. The patient was closely monitored and treated with a standard and individualized triple-drug immunosuppressive therapy throughout her pregnancy. Caesarean section was performed in March 18, 2004, and a health live-born infant was delivered. After the delivery, a 4-year follow-up period indicated that the patient was satisfactory with her condition and her baby was healthy. Our case shows that a successful pregnancy following LT is possible and safe in women with end-stage liver diseases under close monitoring. Three factors including mother, baby, and transplanted liver function must be considered for the safety of high-risk pregnancies.
Collapse
|
29
|
Armenti VT, Constantinescu S, Moritz MJ, Davison JM. Pregnancy after transplantation. Transplant Rev (Orlando) 2008; 22:223-40. [PMID: 18693108 DOI: 10.1016/j.trre.2008.05.001] [Citation(s) in RCA: 90] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The National Transplantation Pregnancy Registry (NTPR) was established in 1991 to study the outcomes of pregnancies in female transplant recipients and pregnancies fathered by male transplant recipients. Data from the NTPR have helped to endorse the reassurances from publications of smaller experiences that successful pregnancies are possible in the transplant population. In our last review for this journal (2000), we noted that important future issues would include the reassessment of prepregnancy guidelines, gestational and organ-specific problems, the role of new immunosuppressive drugs, and the long-term effects of pregnancy on both graft and child. Data collected by the NTPR over the last 7 years have addressed these issues, thus providing additional information for health care providers of transplant recipients of childbearing age. There has been some refinement of prepregnancy guidelines, but there is a need for additional data collection so that organ-specific outcomes and risks can further be identified. To date, the outcomes of the children followed have been encouraging, and specific remote effects have not been identified, but continued surveillance is still vital. Of special concern are the new immunosuppressive drugs, specifically for mycophenolate mofetil (CellCept, Roche Laboratories Inc., Nutley, New Jersey), where data reported to the NTPR and through postmarketing surveillance have shown an increased incidence of nonviable outcomes and a specific pattern and increased incidence of malformation in the newborn, which has resulted in a pregnancy category change. Newer information points to an increased need for vigilance among centers and continued monitoring of pregnancy outcomes in this population. As the first reported pregnancy after transplantation occurred in a kidney recipient 50 years ago, in March 1958, this review also highlights the first reported pregnancies in other solid organ recipients.
Collapse
Affiliation(s)
- Vincent T Armenti
- Department of Pathology, Anatomy, and Cell Biology, Thomas Jefferson University, Philadelphia, PA 19107, USA.
| | | | | | | |
Collapse
|
30
|
Cappell MS. Hepatic disorders severely affected by pregnancy: medical and obstetric management. Med Clin North Am 2008; 92:739-60, vii-viii. [PMID: 18570941 DOI: 10.1016/j.mcna.2008.03.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Hepatic disorders severely affected by pregnancy include choledochal cysts that can be compressed by the gravid uterus and potentially rupture; hepatic adenomas that exhibit accelerated growth because of hyperestrogenemia during pregnancy; acute intermittent porphyria that is exacerbated by increased female sex hormones during pregnancy; splenic artery aneurysms that can rupture during pregnancy because of compression by the gravid uterus; Budd-Chiari syndrome that is promoted by hyperestrogenemia; and hepatitis E and herpes simplex hepatitis that are particularly severe during pregnancy. Hepatic disorders unique to pregnancy include intrahepatic cholestasis of pregnancy; acute fatty liver of pregnancy; preeclampsia and eclampsia; and hemolysis, elevated liver function tests, and low platelet count (HELLP) syndrome. Most disorders uniquely related to pregnancy are treated by prompt fetal delivery as soon as the fetus is sufficiently mature.
Collapse
Affiliation(s)
- Mitchell S Cappell
- Division of Gastroenterology, Department of Medicine, William Beaumont Hospital, MOB 233, 3535 West Thirteen Mile Road, Royal Oak, MI 48073, USA.
| |
Collapse
|
31
|
Jabiry-Zieniewicz Z, Bobrowska K, Pietrzak B, Kaminski P, Kaminski B, Wielgos M, Durlik M, Zieniewicz K. Mode of delivery in women after liver transplantation. Transplant Proc 2008; 39:2796-9. [PMID: 18021990 DOI: 10.1016/j.transproceed.2007.09.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIM A high rate of cesarean sections has been reported among high-risk pregnancies in liver transplant recipients. The aim of this study was to analyze the course of deliveries and the indications for cesarean sections in women after liver transplantation. MATERIALS AND METHODS From 2001 to 2006, we noted 21 deliveries in 17 liver recipients. The mean age of women was 27.9 +/- 6.6 years and the mean time from transplantation to pregnancy was 4.3 +/- 3.6 years. Most patients were primigravidas on tacrolimus-based immunosuppressive regimens. We retrospectively analyzed obstetric data regarding the delivery and the early puerperium. RESULTS We noted 6 vaginal deliveries (29%) and 15 cesarean sections (71%). Mean gestational age in the group of vaginal deliveries was 37.6 +/- 2.2 weeks. No labor complications were noted. All neonates were delivered in a good state (Apgar score from 8 to 10 points) with mean birth weight of 2725 g. All cesarean sections were performed for obstetric indications: fetal distress, breech presentation, intrauterine growth retardation, or complications related to premature labor. Mean gestational age was 37.0 +/- 1.9 weeks. The Apgar scores ranged from 4 to 10 points; mean birth weight was 2787 g. The mean period of hospitalization after surgical labor was 4 days longer compared with the vaginal delivery group. CONCLUSION The high rate of cesarean sections (71%) in liver recipients is associated with a great incidence of obstetric complications of pregnancy. Safe and uneventful vaginal delivery is possible with growing experience in the management of pregnant transplanted women.
Collapse
Affiliation(s)
- Z Jabiry-Zieniewicz
- First Department of Obstetrics and Gynecology, Medical University of Warsaw, Warsaw, Poland
| | | | | | | | | | | | | | | |
Collapse
|
32
|
Abstract
In countries with a high prevalence of chronic hepatitis B, perinatal transmission from mother to infant accounts for the majority of cases of chronic hepatitis B. Passive-active immunoprophylaxis with hepatitis B immunoglobulin and hepatitis B vaccine at birth is 95% efficacious in reducing the risk of HBV transmission but is less effective in HBeAg-positive mothers with very high serum HBV DNA levels. In the last 4 weeks of pregnancy lamivudine may provide additional protection in pregnant women who have high-level viremia. Further studies are needed to evaluate the use of nucleos(t)ide analogues to treat chronic hepatitis B during pregnancy.
Collapse
Affiliation(s)
- Maya Gambarin-Gelwan
- Division of Gastroenterology and Hepatology, Weill Cornell Medical College of Cornell University, 1305 York Avenue, 4th floor, New York, NY 10021, USA.
| |
Collapse
|
33
|
Jabiry-Zieniewicz Z, Bobrowska K, Kaminski P, Wielgos M, Zieniewicz K, Krawczyk M. Low-dose hormonal contraception after liver transplantation. Transplant Proc 2007; 39:1530-2. [PMID: 17580181 DOI: 10.1016/j.transproceed.2007.02.063] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2006] [Revised: 12/20/2006] [Accepted: 02/05/2007] [Indexed: 10/23/2022]
Abstract
OBJECTIVES End-stage liver failure is associated with extremely reduced fertility. After liver transplantation, restoration of menstrual function is observed; thus effective contraceptive methods should be employed in patients who do not plan to conceive. The aim of this study was to assess tolerability and safety of hormonal contraceptives in female liver transplant recipients. MATERIALS AND METHODS We retrospectively analyzed data on 15 female liver graft recipients, aged 24 to 35 years, who used hormonal contraceptives after liver transplantation for a time not shorter than 12 months. The period from grafting to administration of hormonal contraceptives varied from 6 months to 7 years. Biochemical parameters of liver function, fasting glucose levels, body mass index (BMI) as well as blood pressure were monitored at 0, 3, 6, and 12 months of therapy. Side effects of the treatment were noted on regular follow-up examinations. RESULTS No case of pregnancy or graft rejection was observed on therapy. Changes of biochemical parameters were not significant (aspartate transferase 22.92 +/- 6.67 vs 25.54 +/- 7.90, alanine transferase 22.08 +/- 5.66 vs 24.27 +/- 7.57, total bilirubin 0.96 +/- 0.17 vs 1.02 +/- 0.15). Blood pressure and BMI remained stable in the group. None of the patients discontinued therapy for medical indications. CONCLUSION Hormonal contraception was administered as soon as liver transplant function was stable. It was effective, well tolerated, and did not seem to impair graft function. However, a long-term prospective study is necessary to assess the safety of hormonal contraception in transplant recipients.
Collapse
Affiliation(s)
- Z Jabiry-Zieniewicz
- First Department of Obstetrics and Gynecology, Medical University of Warsaw, Starynkiewicza Sq. 1/3, Warsaw 02-015, Poland
| | | | | | | | | | | |
Collapse
|
34
|
Josephson MA, McKay DB. Considerations in the medical management of pregnancy in transplant recipients. Adv Chronic Kidney Dis 2007; 14:156-67. [PMID: 17395118 DOI: 10.1053/j.ackd.2007.01.006] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Pregnancy, although rare in the patient with end-stage renal disease, is not uncommon in the transplant recipient. Physicians taking care of transplant recipients must be able to inform patients about the potential risks of pregnancy in this setting. The patient and her partner must know that the risks associated with pregnancy increase with worsening kidney function and hypertension. Current consensus opinion is that pregnancy can be relatively safely undertaken by 1 year after transplant if the patient has had no rejections during the year, allograft function is adequate, there are no infections that could affect the fetus, the patient is not taking teratogenic medications, and immunosuppressive medication dosing is stable. Consideration must be given to immunosuppression during pregnancy both with respect to the specific agents as well as the level of dosing. None of the medications are FDA category A; all are B or higher. Part of planning for pregnancy should include an evaluation of immunosuppression medication and a plan to modify the regimen prior to conception if its use may be risky for the developing fetus. Rejection can occur during a kidney transplant, so maintaining adequate immunosuppression is important. Other issues that need to be managed when caring for a pregnant transplant patient include: potential for infection (urinary tract infections are very common), hypertension, and anemia. The type of delivery, posttransplant contraception, and breast-feeding also need to be addressed.
Collapse
|
35
|
Ducarme G, Théron-Gérard L, Duvoux C, Uzan M, Poncelet C. Pregnancy after liver transplantation with tacrolimus. Eur J Obstet Gynecol Reprod Biol 2006; 133:249-50. [PMID: 16908095 DOI: 10.1016/j.ejogrb.2006.07.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2005] [Revised: 04/26/2006] [Accepted: 07/06/2006] [Indexed: 10/24/2022]
|
36
|
Christopher V, Al-Chalabi T, Richardson PD, Muiesan P, Rela M, Heaton ND, O'Grady JG, Heneghan MA. Pregnancy outcome after liver transplantation: a single-center experience of 71 pregnancies in 45 recipients. Liver Transpl 2006; 12:1138-43. [PMID: 16799943 DOI: 10.1002/lt.20810] [Citation(s) in RCA: 108] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Infertility is common in women with end-stage liver disease. Successful liver transplant (LT), however, can restore childbearing potential. Controversy exists regarding the most appropriate immunosuppressive regimen and timing of conception following LT. We report the outcomes of a review of all pregnancies occurring following LT at King's College Hospital, London, from 1988 to 2004. Seventy-one pregnancies were recorded in 45 women. Tacrolimus (60%) and cyclosporin A (38%) were the predominant primary immunosuppressive agents used. Median age at conception was 29 years (range, 19-42), with a median time from LT to conception of 40 months (range, 1-111). There were 50 live births, and no maternal or fetal deaths related to pregnancy. There were no graft losses. Median gestation was 37 weeks (range, 24-42) with a median birth weight of 2,690 g (range, 554-4,260). Caesarean section was performed in 40% of pregnancies. Complications included pregnancy-induced hypertension in 20%, preeclampsia in 13%, acute cellular rejection in 17%, and renal impairment in 11%. There was no statistically significant difference in complication rates observed between immunosuppressive groups. Pregnancies occurring within 1-year posttransplant had an increased incidence of prematurity, low birth weight, and acute cellular rejection compared to those occurring later than 1 year. In conclusion, this study confirms that favorable outcomes of pregnancy post-LT can be expected for the majority of patients. However, delaying pregnancy until after 1-year post-LT is advisable, since doing so maybe associated with a lower risk of prematurity.
Collapse
|
37
|
|
38
|
Jabiry-Zieniewicz Z, Kamiński P, Pietrzak B, Cyganek A, Bobrowska K, Ziółkowski J, Ołdakowska-Jedynak U, Zieniewicz K, Paczek L, Jankowska I, Wielgoś M, Krawczyk M. Outcome of Four High-Risk Pregnancies in Female Liver Transplant Recipients on Tacrolimus Immunosuppression. Transplant Proc 2006; 38:255-7. [PMID: 16504718 DOI: 10.1016/j.transproceed.2005.12.044] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Pregnancies in women after liver transplantation are considered high risk due to the greater rate of complications observed in immunosuppressed graft recipients. We report successful outcomes of four high-risk pregnancies in female liver transplant recipients on tacrolimus-based immunosuppression. The patients, aged 23 to 32 years, at the time of conception were 12 to 59 months from transplantation (mean 30 months). Preterm labor was the most important pregnancy complication observed in these patients. One episode of acute graft rejection was observed. A variable demand for tacrolimus was noted during pregnancy. Despite complications all four pregnancies were successful. The mean gestational age at delivery was 34.4 weeks. The birth weight of the newborns varied from 1410 to 3490 g (mean 2303 g) and the mean Apgar score was 8. No structural malformations or early complications were observed in the newborns. Excluding the patient with acute rejection, the remaining three cases showed all liver parameters to remain stable.
Collapse
Affiliation(s)
- Z Jabiry-Zieniewicz
- First Department of Obstetrics and Gynecology, Warsaw Medical University, Pl. Starynkiewicza 1/3, 02-015 Warsaw, Poland
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
39
|
Jabiry-Zieniewicz Z, Cyganek A, Luterek K, Bobrowska K, Kamiński P, Ziółkowski J, Zieniewicz K, Krawczyk M. Pregnancy and delivery after liver transplantation. Transplant Proc 2005; 37:1197-200. [PMID: 15848667 DOI: 10.1016/j.transproceed.2005.01.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
AIM According to statistics, women constitute one-third of all liver recipients and approximately 75% of female recipients are of reproductive age. Successful liver transplantation in these patients results in the restoration of menstrual function and fertility. The aim of this study was to assess the course of pregnancy and delivery in liver-transplanted women. MATERIALS AND METHODS We retrospectively analyzed data of 138 liver-transplanted women, aged from 18 to 63 years, who underwent regular gynecological evaluations. Among 77 patients of reproductive age, 11 women conceived and delivered babies. RESULTS All patients have successfully delivered. The mean gestation age at delivery was 36.5 weeks. All neonates were delivered in a good state with no congenital abnormalities. Common pregnancy complications were preterm birth, anemia, intrahepatic cholestasis, and infection. In 1 case, graft rejection was observed due to willful discontinuation of immunosuppressive therapy. Two spontaneous vaginal deliveries and 9 caesarean sections were performed. All caesarean sections were performed for obstetrical indications: fetal intrauterine asphyxia (n = 4), breech presentation (n = 2), threatening intrauterine infection (n = 2), and preterm twin delivery (n = 1). CONCLUSION High-risk pregnancies in liver-transplanted women are generally associated with good outcomes, although an increased rate of preterm labor, intrauterine infections, anemia, and cholestasis were observed. Pregnancy did not seem to impair graft function or accelerate rejection in patients receiving immunosuppressive therapy.
Collapse
Affiliation(s)
- Z Jabiry-Zieniewicz
- First Department of Obstetrics and Gynecology, The Medical University of Warsaw, Warsaw, Poland
| | | | | | | | | | | | | | | |
Collapse
|
40
|
Hold PM, Wong CF, Dhanda RK, Walkinshaw SA, Bakran A. Successful renal transplantation during pregnancy. Am J Transplant 2005; 5:2315-7. [PMID: 16095516 DOI: 10.1111/j.1600-6143.2005.00993.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Little is known about the implications of performing a renal transplant on a patient who is already pregnant. This case study reports a successful outcome of pregnancy, diagnosed coincidentally following renal transplantation at 13 weeks gestation. The recipient was a 23-year-old woman with chronic kidney disease who received a live-related renal transplant from her father. Pregnancy was discovered at routine ultrasound scanning of the renal allograft at 5 days posttransplant and estimated at 13 weeks gestation. She received ciclosporin monotherapy as immunosuppression throughout the pregnancy, and was given valacyclovir as prophylaxis against cytomegalovirus (CMV) infection. Renal function remained stable throughout the pregnancy, which progressed normally, resulting in the vaginal delivery of a healthy, liveborn male infant at 37 weeks gestation. This case study demonstrates that transplantation during pregnancy can have a successful outcome.
Collapse
Affiliation(s)
- Phoebe M Hold
- The Transplant Unit, Royal Liverpool University Hospital, Liverpool, UK.
| | | | | | | | | |
Collapse
|
41
|
Abstract
OBJECTIVE To study pregnancy outcome before and after organ transplantation. DESIGN Registry study. SETTING Swedish Health Registers. POPULATION All births in Sweden 1973-2002. METHODS Women who had organ transplantation were identified from the Hospital Discharge Register and their deliveries before and after the transplantation were identified from the Medical Birth Register. Abortions requiring hospitalisation were identified from the Hospital Discharge Register. Outcomes were compared with those in the total population. Adjustments were made for maternal age, parity and smoking habits. MAIN OUTCOME MEASURES Miscarriage, preterm delivery, low birthweight, small for gestational age, congenital malformations, infant death, pre-eclampsia and placental abruption. RESULTS A total of 980 infants born before and 152 born after transplantation were identified. A high frequency of pre-eclampsia (22%), preterm birth (46%), low birthweight (41%), small for gestational age (16%) and infant death (5% before the age of one) were found for deliveries after transplantation but similar frequencies were found also among deliveries a few years before transplantation. No significant increase in congenital malformation rate was seen. Among 15 infants born after liver transplantation, 2 were malformed. CONCLUSIONS Pregnancies after organ transplantation have an increased risk of complications but this is similar to pregnancies occurring before the transplantation.
Collapse
|
42
|
Liaw YF, Leung N, Guan R, Lau GKK, Merican I, McCaughan G, Gane E, Kao JH, Omata M. Asian-Pacific consensus statement on the management of chronic hepatitis B: a 2005 update. Liver Int 2005; 25:472-89. [PMID: 15910483 DOI: 10.1111/j.1478-3231.2005.01134.x] [Citation(s) in RCA: 265] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
BACKGROUND/AIMS A large amount of new data on the treatment of chronic hepatitis B has become available such that the 2003 consensus statement requires revision and update. METHODS New data were presented, discussed and debated in an expert pre-meeting to draft a revision. The revised contents were finalized after discussion in a general meeting of APASL. RESULTS Conceptual background, including the efficacy and safety profile of currently available and emerging drugs, was reviewed. Nineteen recommendations were formed and unresolved issues and areas for further study were suggested. CONCLUSION The current therapy of chronic hepatitis B is modestly effective but not satisfactory. The development of new drugs and new strategies is required to further improve the outcomes of treatment.
Collapse
Affiliation(s)
- Yun-Fan Liaw
- Liver Research Unit, Chang Gung Memorial Hospital, Taipei, Taiwan.
| | | | | | | | | | | | | | | | | |
Collapse
|
43
|
Parolin MB, Rabinovitch I, Urbanetz AA, Scheidemantel C, Cat ML, Coelho JCU. Impact of successful liver transplantation on reproductive function and sexuality in women with advanced liver disease. Transplant Proc 2005; 36:943-4. [PMID: 15194326 DOI: 10.1016/j.transproceed.2004.03.124] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Abnormalities in the reproductive function and sexuality, which are common among women with advanced liver disease, may reverse after successful liver transplantation (LT). To analyze reproductive function and sexuality in women who underwent successful LT, we interviewed 28 recipients (mean age 44.17 +/- 13.6 years old) at a median posttransplant survival of 36.5 months (range, 6 to 110 months), with good graft function and obeying regular follow-up at our institution. In addition to medical records, all subjects answered a questionnaire on their menstrual pattern, sexual activity, contraceptive practice, pregnancy, and sexuality domain. Nineteen of 22 patients in the child bearing age (86.4%) recovered menstrual function at a median of 1 month after LT (range, 1 to 7 months). Twenty of 28 recipients (71.4%) were sexually active. The most frequent contraceptive practices were barrier methods and tubal ligation. There were four successful pregnancies (one twin) in three patients; five healthy babies were delivered. Overall, 70% of sexually active patients indicated satisfaction with their relationship, 75% had weekly intercourse, and 70% experienced orgasm with intercourse. Eighty percent expressed a desire to receive information concerning sexuality. In conclusion, LT has a positive impact on sexuality and reproductive function in female recipients. It would desirable that LT programs included information regarding these issues for this population.
Collapse
Affiliation(s)
- M B Parolin
- Department of Surgery, Liver Transplantation Unit, Hospital de Clinicas of the Federal University of Parana, Curitiba, Brazil.
| | | | | | | | | | | |
Collapse
|
44
|
Gandhi H, Davies N. Liver transplant and obstetrics. J OBSTET GYNAECOL 2005; 24:771-3. [PMID: 15763785 DOI: 10.1080/014436104100009477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- H Gandhi
- University Hospital of Wales, Cardiff, Wales, UK.
| | | |
Collapse
|
45
|
Loreno M, Bo P, Senzolo M, Cillo U, Naoumov N, Burra P. Successful pregnancy in a liver transplant recipient treated with lamivudine for de novo hepatitis B in the graft. Transpl Int 2004. [DOI: 10.1111/j.1432-2277.2004.tb00502.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
46
|
Jankowska I, Oldakowska-Jedynak U, Jabiry-Zieniewicz Z, Cyganek A, Pawlowska J, Teisseyre M, Kalicinski P, Markiewicz M, Paczek L, Socha J. Absence of teratogenicity of sirolimus used during early pregnancy in a liver transplant recipient. Transplant Proc 2004; 36:3232-3. [PMID: 15686735 DOI: 10.1016/j.transproceed.2004.11.102] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
We describe the case of successful delivery in a 21-year-old woman who became pregnant 3 years after liver transplantation and who received sirolimus during the first 6 weeks of gestation. Sirolimus was discontinued when ultrasonography revealed a pregnancy, she was switched to tacrolimus and prednisone was continued. The course of pregnancy was uneventful; there were no signs or symptoms of graft rejection. Due to fetal intrauterine threatening asphyxia the pregnancy was concluded by cesarean section in the 39th gestational week, delivering a healthy, 2950 g, Apgar 10, female infant.
Collapse
Affiliation(s)
- I Jankowska
- Department of Gastroenterology, Hepatology and Immunology, The Children's Memorial Health Institute, Warsaw, Poland
| | | | | | | | | | | | | | | | | | | |
Collapse
|
47
|
Loreno M, Bo P, Senzolo M, Cillo U, Naoumov N, Burra P. Successful pregnancy in a liver transplant recipient treated with lamivudine for de novo hepatitis B in the graft. Transpl Int 2004; 17:730-4. [PMID: 15717218 DOI: 10.1007/s00147-004-0785-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2003] [Revised: 02/12/2004] [Accepted: 03/05/2004] [Indexed: 02/07/2023]
Abstract
Pregnancy is often successful after liver transplantation, despite the potentially toxic effects of immunosuppressive drug therapy. Liver transplant recipients with recurrent hepatitis C or hepatitis B nonetheless appear to be at risk of a worse graft function in the event of pregnancy, and antiviral drugs are generally contraindicated in pregnancy because of their teratogenic effects. A 33-year-old woman had undergone liver transplantation for Caroli's disease 6 years previously. Two years later the patient experienced de novo HBV hepatitis. Lamivudine treatment (100 mg/day) was started and clearance of HBsAg was documented 1 year later. Four years after starting antiviral treatment the patient became pregnant, despite of the risk of teratogenic effects; lamivudine, cyclosporine and azathioprine were not discontinued for risk of break-through hepatitis and acute or chronic rejection. The course of gestation was uneventful and caesarean section was performed after 36 weeks. The newborn infant was a healthy male weighing 3,080 g and measuring 50 cm.
Collapse
Affiliation(s)
- Massimiliano Loreno
- Department of Surgical and Gastroenterological Sciences, University of Padua, Via Giustiniani 2, 35128, Padua, Italy
| | | | | | | | | | | |
Collapse
|
48
|
Abstract
The frequency and variety of solid organ transplantation in reproductive-age women increases each year. Pregnancy is no longer contraindicated in transplant recipients provided that their graft is functioning well and they are in good general health. Physicians who care for pregnant transplant recipients should be aware of the surmounting data that are available in the literature and through registries of maternal, fetal, and neonatal risks and complications as well as outcome data. Newer immunosuppressive agents preserve graft function and registry data attest to their safety in pregnancy. For optimal maternal and neonatal outcomes, a multispecialty care approach that includes the obstetrician/maternal-fetal specialist,transplant team, anesthesiologist, and neonatal team is prudent when caring for pregnancies after organ transplantation.
Collapse
Affiliation(s)
- Joan M Mastrobattista
- Department of Obstetrics, Gynecology, & Reproductive Sciences, University of Texas Health Science Center at Houston, 6431 Fannin, Suite 3.604, Houston, TX 77030, USA.
| | | |
Collapse
|
49
|
|
50
|
Parolin MB, Rabinovich I, Urbanetz A, Scheidemantel C, Cat ML, Coelho JCU. Função sexual e reprodutiva em receptoras de transplante hepático. ARQUIVOS DE GASTROENTEROLOGIA 2004; 41:10-7. [PMID: 15499418 DOI: 10.1590/s0004-28032004000100003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
RACIONAL: Anormalidades na função sexual e reprodutiva são comuns em pacientes com hepatopatia crônica avançada e podem ser revertidas após transplante hepático bem-sucedido. OBJETIVO: Avaliar aspectos da função sexual e reprodutiva em mulheres submetidas a transplante de fígado no Serviço de Transplante Hepático do Hospital de Clínicas da Universidade Federal do Paraná, Curitiba, PR. PACIENTES E MÉTODOS: Entre setembro de 1991 e dezembro de 2001, 94 mulheres foram submetidas a transplante hepático. Vinte e oito delas (idade média 44,17 ± 13,60 anos) preencheram os seguintes critérios de inclusão: idade > 16 anos na época do transplante, sobrevida pós-transplante > 6 meses, estar em acompanhamento regular no Serviço na época do estudo e concordância em participar do mesmo. Os prontuários médicos foram revisados e as pacientes responderam a um questionário abordando padrão dos ciclos menstruais no pré e pós-transplante, gravidez no pós-transplante, métodos contraceptivos no pré e pós-transplante, freqüência de realização de citologia oncótica cervical no pré e pós-transplante, ocorrência de neoplasia ginecológica pós-transplante, além de questionário específico para o domínio da sexualidade no período pós-transplante. RESULTADOS: A mediana do tempo de seguimento pós-transplante das 28 pacientes foi de 36,5 meses (6-110 meses) e a principal indicação para o transplante foi cirrose associada à hepatite C (25%). Todas as pacientes apresentavam função normal do enxerto. Excluindo-se 6 pacientes em menopausa (natural ou cirúrgica), 13 das 22 pacientes (59,1%) com potencial de menstruar apresentavam amenorréia no ano anterior ao transplante. Dezenove dessas 22 pacientes (86,4%) reassumiram os ciclos menstruais após o transplante, com mediana de 1 mês pós-transplante (1 a 7 meses). Todas as pacientes com idade inferior a 45 anos voltaram a menstruar após o transplante. Quatro gestações bem-sucedidas ocorreram em três pacientes, sendo uma gestação gemelar. Cerca de 70% das transplantadas realizavam exame de citologia oncótica cervical pelo menos uma vez ao ano. Um caso de carcinoma adenoescamoso de endométrio foi identificado em uma paciente de 64 anos, 36 meses após o transplante, tratado cirurgicamente com sucesso. Cerca de 71,4% das pacientes referiram vida sexual ativa pós-transplante, sendo que 70% delas consideravam-na satisfatória. CONCLUSÕES: Após transplante hepático bem-sucedido, a maioria das mulheres em idade fértil reassumem os ciclos menstruais poucos meses após o transplante, tornando possível a ocorrência de gestações. Devido ao rápido retorno da libido e da fertilidade, as pacientes devem ser esclarecidas sobre métodos contraceptivos seguros após o transplante. A maioria das pacientes apresenta vida sexual ativa e satisfatória e realiza regularmente citologia oncótica cervical.
Collapse
Affiliation(s)
- Mônica Beatriz Parolin
- Serviço de Transplante Hepático, Hospital de Clínicas da Universidade Federal do Paraná.
| | | | | | | | | | | |
Collapse
|