1
|
Coscia LA, Kliniewski D, Constantinescu S, Moritz MJ. Pregnancy after transplant in the older adolescent: Anticipatory guidance for the pediatric provider. Pediatr Transplant 2024; 28:e14752. [PMID: 38682682 DOI: 10.1111/petr.14752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 03/21/2024] [Accepted: 03/25/2024] [Indexed: 05/01/2024]
Abstract
BACKGROUND Healthcare providers who care for adolescent and young adult transplant recipients should be aware of contraception counseling and potential for pregnancy in this at-risk cohort. METHODS This paper will review contraceptive options in general for transplant recipients. There will also be a review of common immunosuppressive medications and their risk profile regarding pregnancy after transplantation. Data from the Transplant Pregnancy Registry International were analyzed looking at recipients conceiving under the age of 21 and were compared to overall pregnancy outcomes. RESULTS Overall pregnancy outcomes in recipients under the age of 21 are like the adult cohort. CONCLUSION It is imperative to provide contraception counseling to the adolescent and young adult and inform their caregiver that pregnancy can happen if the recipient is sexually active. Pregnant adolescent and young adult transplant recipients should be followed by a multidisciplinary team to assure a positive outcome for the recipient, transplant, and neonate.
Collapse
Affiliation(s)
- Lisa A Coscia
- Transplant Pregnancy Registry International, a division of Gift of Life Institute, Philadelphia, Pennsylvania, USA
| | - Dorothy Kliniewski
- Transplant Pregnancy Registry International, a division of Gift of Life Institute, Philadelphia, Pennsylvania, USA
| | - Serban Constantinescu
- Transplant Pregnancy Registry International, a division of Gift of Life Institute, Philadelphia, Pennsylvania, USA
- Department of Medicine, Section of Nephrology, Hypertension and Kidney Transplantation, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
| | - Michael J Moritz
- Transplant Pregnancy Registry International, a division of Gift of Life Institute, Philadelphia, Pennsylvania, USA
| |
Collapse
|
2
|
Kittleson MM, DeFilippis EM, Bhagra CJ, Casale JP, Cauldwell M, Coscia LA, D'Souza R, Gaffney N, Gerovasili V, Ging P, Horsley K, Macera F, Mastrobattista JM, Paraskeva MA, Punnoose LR, Rasmusson KD, Reynaud Q, Ross HJ, Thakrar MV, Walsh MN. Reproductive health after thoracic transplantation: An ISHLT expert consensus statement. J Heart Lung Transplant 2023; 42:e1-e42. [PMID: 36528467 DOI: 10.1016/j.healun.2022.10.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 10/10/2022] [Indexed: 11/16/2022] Open
Abstract
Pregnancy after thoracic organ transplantation is feasible for select individuals but requires multidisciplinary subspecialty care. Key components for a successful pregnancy after lung or heart transplantation include preconception and contraceptive planning, thorough risk stratification, optimization of maternal comorbidities and fetal health through careful monitoring, and open communication with shared decision-making. The goal of this consensus statement is to summarize the current evidence and provide guidance surrounding preconception counseling, patient risk assessment, medical management, maternal and fetal outcomes, obstetric management, and pharmacologic considerations.
Collapse
Affiliation(s)
- Michelle M Kittleson
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California.
| | - Ersilia M DeFilippis
- Division of Cardiology, New York Presbyterian-Columbia University Irving Medical Center, New York, New York
| | - Catriona J Bhagra
- Department of Cardiology, Cambridge University and Royal Papworth NHS Foundation Trusts, Cambridge, UK
| | - Jillian P Casale
- Department of Pharmacy Services, University of Maryland Medical Center, Baltimore, Maryland
| | - Matthew Cauldwell
- Department of Obstetrics, Maternal Medicine Service, St George's Hospital, London, UK
| | - Lisa A Coscia
- Transplant Pregnancy Registry International, Gift of Life Institute, Philadelphia, Pennsylvania
| | - Rohan D'Souza
- Division of Maternal and Fetal Medicine, Department of Obstetrics and Gynecology, McMaster University, Hamilton, Ontario, Canada
| | - Nicole Gaffney
- Lung Transplant Service, Alfred Hospital, Melbourne, Australia; Department of Medicine, Central Clinical School, Monash University, Melbourne, Australia
| | | | - Patricia Ging
- Department of Pharmacy, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Kristin Horsley
- Department of Obstetrics and Gynecology, McMaster University, Hamilton, Ontario, Canada
| | - Francesca Macera
- De Gasperis Cardio Center and Transplant Center, Niguarda Hospital, Milan, Italy; Dept of Cardiology, Cliniques Universitaires de Bruxelles - Hôpital Erasme, Brussels, Belgium
| | - Joan M Mastrobattista
- Department of Obstetrics & Gynecology, Division of Maternal-Fetal Medicine, Baylor College of Medicine Houston, Texas
| | - Miranda A Paraskeva
- Lung Transplant Service, Alfred Hospital, Melbourne, Australia; Department of Medicine, Central Clinical School, Monash University, Melbourne, Australia
| | - Lynn R Punnoose
- Vanderbilt Heart and Vascular Institute, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Quitterie Reynaud
- Cystic Fibrosis Adult Referral Care Centre, Department of Internal Medicine, Hospices civils de Lyon, Pierre Bénite, France
| | - Heather J Ross
- Peter Munk Cardiac Centre of the University Health Network, Toronto, Ontario, Canada; Ted Rogers Centre for Heart Research, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada
| | - Mitesh V Thakrar
- Department of Medicine, Division of Respirology, University of Calgary, Calgary, Alberta, Canada
| | | |
Collapse
|
3
|
Berardinelli L, Dallatana R, Beretta C, Raiteri M, Tonello G, Quaglia F, Vegeto A. Pregnancy in kidney recipients under cyclosporine. Transpl Int 2018. [DOI: 10.1111/tri.1992.5.s1.480] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
4
|
Affiliation(s)
- J M Davison
- MRC Human Reproduction Group Princess Mary Maternity Hospital, Newcastle upon Tyne NE2 3BD
| |
Collapse
|
5
|
McGrory CH, Ondeck-Williams M, Hilburt N, Constantinescu S, Silva P, Daller JA, Coscia LA, Armenti VT. Nutrition, Pregnancy, and Transplantation. Nutr Clin Pract 2017; 22:512-6. [PMID: 17906276 DOI: 10.1177/0115426507022005512] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
One benefit of transplantation, along with the restoration of health, is the opportunity for successful pregnancies. A growing number of pregnancies have been reported among all types of solid-organ recipients. There is an increasing need for practice guidelines that include nutrition information in order to assist practitioners caring for and counseling these high-risk patients. In the transplant community, guidelines for managing pregnancies in transplant recipients have been evolving but lack specific nutrition recommendations. As for all pregnancies, there is a need to optimize nutrition for the mother and her infant, with additional consideration given to the transplant recipient's graft. This article reviews outcomes of posttransplant pregnancies and management guidelines, with special emphasis on nutrition in this unique population.
Collapse
|
6
|
Rose C, Gill J, Zalunardo N, Johnston O, Mehrotra A, Gill JS. Timing of Pregnancy After Kidney Transplantation and Risk of Allograft Failure. Am J Transplant 2016; 16:2360-7. [PMID: 26946063 DOI: 10.1111/ajt.13773] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Revised: 02/12/2016] [Accepted: 02/12/2016] [Indexed: 01/25/2023]
Abstract
The optimal timing of pregnancy after kidney transplantation remains uncertain. We determined the risk of allograft failure among women who became pregnant within the first 3 posttransplant years. Among 21 814 women aged 15-45 years who received a first kidney-only transplant between 1990 and 2010 captured in the United States Renal Data System, n = 729 pregnancies were identified using Medicare claims. The probability of allograft failure from any cause including death (ACGL) at 1, 3, and 5 years after pregnancy was 9.6%, 25.9%, and 36.6%. In multivariate analyses, pregnancy in the first posttransplant year was associated with an increased risk of ACGL (hazard ratio [HR]: 1.18; 95% confidence interval [CI] 1.00, 1.40) and death censored graft loss (DCGL) (HR:1.25; 95% CI 1.04, 1.50), while pregnancy in the second posttransplant year was associated with an increased risk of DCGL (HR: 1.26; 95% CI 1.06, 1.50). Pregnancy in the third posttransplant year was not associated with an increased risk of ACGL or DCGL. These findings demonstrate a higher incidence of allograft failure after pregnancy than previously reported and that the increased risk of allograft failure extends to pregnancies in the second posttransplant year.
Collapse
Affiliation(s)
- C Rose
- Division of Nephrology, University of British Columbia, Vancouver, British Columbia, Canada
| | - J Gill
- Division of Nephrology, University of British Columbia, Vancouver, British Columbia, Canada.,Centre for Health Evaluation and Outcomes Sciences, University of British Columbia, Vancouver, Canada
| | - N Zalunardo
- Division of Nephrology, University of British Columbia, Vancouver, British Columbia, Canada
| | - O Johnston
- Division of Nephrology, University of British Columbia, Vancouver, British Columbia, Canada
| | - A Mehrotra
- Division of Nephrology, Mount Sinai School of Medicine, New York, NY
| | - J S Gill
- Division of Nephrology, University of British Columbia, Vancouver, British Columbia, Canada.,Centre for Health Evaluation and Outcomes Sciences, University of British Columbia, Vancouver, Canada.,Tufts-New England Medical Center, Boston, MA
| |
Collapse
|
7
|
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.
Collapse
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
| | | | | |
Collapse
|
8
|
Boubaker K, Mahfoudhi M, Abderrahim E, Ben Abdallah T, Kheder A. [Pregnancy and kidney transplantation: report of 10 cases]. Pan Afr Med J 2015; 20:292. [PMID: 26161215 PMCID: PMC4483364 DOI: 10.11604/pamj.2015.20.292.4510] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Accepted: 05/10/2014] [Indexed: 11/13/2022] Open
Abstract
La grossesse chez les patientes transplantées rénales est à risque de complications maternelles mais surtout fœtales. Le risque de survenue de rejet aigue ou chronique inhérent à la grossesse est faible. L'objectif de notre étude était de rapporter les grossesses survenues chez nos transplantées rénales, leurs aspects évolutifs et une revue de la littérature. L’âge moyen des patientes au moment de la transplantation rénale était de 28,5 ans. Le traitement immunosuppresseur d'entretien a associé une corticothérapie, l'azathioprine et/ou la ciclosporine A. Le délai moyen entre la transplantation rénale et la découverte de la grossesse était de 6,5 ans. L’âge moyen au moment de la conception était de 33,8 ans. Il n'ya pas eu de modifications du traitement immunosuppresseur au cours de la grossesse. La créatininémie moyenne au cours de la grossesse était stable à 104,8 µmol/l avec une créatininémie supérieure à 150 µmol/l dans 2 cas. Les complications maternelles au cours de la grossesse étaient une hypertension artérielle gravidique dans 3 cas, une protéinurie dans 3 cas, une ascension de la créatininémie au 7ème mois dans 2 cas, une cholestase hépatique gravidique dans 2 cas et une hyperuricémie dans 4 cas. Une prématurité était observée dans 3 cas en rapport avec une rupture prématurée des membranes, des contractions utérines sur utérus cicatriciel et des signes de prééclampsie dans le troisième cas. Après l'accouchement, Une hypertension artérielle était observée chez 3 patientes. On n'a pas noté de rejet aigu chez nos patientes. La créatininémie moyenne était de 195,3 µmol/l (74- 553 µmol/l). Le développement statural et psychomoteur était normal pour 9 enfants. La bonne évolution des grossesses chez les patientes transplantées rénales une planification et un suivi régulier.
Collapse
Affiliation(s)
- Karima Boubaker
- Service de Médecine Interne A, Hôpital Charles Nicolle, Tunis, Tunisie
| | - Madiha Mahfoudhi
- Service de Médecine Interne A, Hôpital Charles Nicolle, Tunis, Tunisie
| | | | | | - Adel Kheder
- Service de Médecine Interne A, Hôpital Charles Nicolle, Tunis, Tunisie
| |
Collapse
|
9
|
Delesalle AS, Robin G, Provôt F, Dewailly D, Leroy-Billiard M, Peigné M. [Impact of end-stage renal disease and kidney transplantation on the reproductive system]. ACTA ACUST UNITED AC 2014; 43:33-40. [PMID: 25530544 DOI: 10.1016/j.gyobfe.2014.11.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Accepted: 11/17/2014] [Indexed: 10/24/2022]
Abstract
Chronic renal failure leads to many metabolic disorders affecting reproductive function. For men, hypergonadotropic hypogonadism, hyperprolactinemia, spermatic alterations, decreased libido and erectile dysfunction are described. Kidney transplantation improves sperm parameters and hormonal function within 2 years. But sperm alterations may persist with the use of immunosuppressive drugs. In women, hypothalamic-pituitary-ovarian axis dysfunction due to chronic renal failure results in menstrual irregularities, anovulation and infertility. After kidney transplantation, regular menstruations usually start 1 to 12 months after transplantation. Fertility can be restored but luteal insufficiency can persist. Moreover, 4 to 20% of women with renal transplantation suffer from premature ovarian failure syndrome. In some cases, assisted reproductive technologies can be required and imply risks of ovarian hyperstimulation syndrome and must be performed with caution. Pregnancy risks for mother, fetus and transplant are added to assisted reproductive technologies ones. Only 7 authors have described assisted reproductive technologies for patients with kidney transplantation. No cases of haemodialysis patients have been described yet. So, assisted reproductive technologies management requires a multidisciplinary approach with obstetrics, nephrology and reproductive medicine teams' agreement.
Collapse
Affiliation(s)
- A-S Delesalle
- Service de gynécologie endocrinienne et médecine de la reproduction, hôpital Jeanne-de-Flandres, CHRU de Lille, 2, avenue Oscar-Lambret, 59037 Lille cedex, France.
| | - G Robin
- Service de gynécologie endocrinienne et médecine de la reproduction, hôpital Jeanne-de-Flandres, CHRU de Lille, 2, avenue Oscar-Lambret, 59037 Lille cedex, France; Service d'andrologie, hôpital Albert-Calmette, CHRU de Lille, 2, avenue Oscar-Lambret, 59037 Lille cedex, France
| | - F Provôt
- Service de néphrologie, hôpital Claude-Huriez, CHRU de Lille, 2, avenue Oscar-Lambret, 59037 Lille cedex, France
| | - D Dewailly
- Service de gynécologie endocrinienne et médecine de la reproduction, hôpital Jeanne-de-Flandres, CHRU de Lille, 2, avenue Oscar-Lambret, 59037 Lille cedex, France
| | - M Leroy-Billiard
- Service de gynécologie endocrinienne et médecine de la reproduction, hôpital Jeanne-de-Flandres, CHRU de Lille, 2, avenue Oscar-Lambret, 59037 Lille cedex, France
| | - M Peigné
- Service de gynécologie endocrinienne et médecine de la reproduction, hôpital Jeanne-de-Flandres, CHRU de Lille, 2, avenue Oscar-Lambret, 59037 Lille cedex, France
| |
Collapse
|
10
|
You JY, Kim MK, Choi SJ, Oh SY, Kim SJ, Kim JH, Oh HY, Roh CR. Predictive factors for adverse pregnancy outcomes after renal transplantation. Clin Transplant 2014; 28:699-706. [DOI: 10.1111/ctr.12367] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Ji Yeon You
- Department of Obstetrics and Gynecology; Samsung Medical Center; Sungkyunkwan University School of Medicine; Seoul Korea
| | - Moon-Kyung Kim
- Department of Obstetrics and Gynecology; Samsung Medical Center; Sungkyunkwan University School of Medicine; Seoul Korea
| | - Suk-Joo Choi
- Department of Obstetrics and Gynecology; Samsung Medical Center; Sungkyunkwan University School of Medicine; Seoul Korea
| | - Soo-young Oh
- Department of Obstetrics and Gynecology; Samsung Medical Center; Sungkyunkwan University School of Medicine; Seoul Korea
| | - Sung-Joo Kim
- Department of Surgery; Samsung Medical Center; Sungkyunkwan University School of Medicine; Seoul Korea
| | - Jong-Hwa Kim
- Department of Obstetrics and Gynecology; Samsung Medical Center; Sungkyunkwan University School of Medicine; Seoul Korea
| | - Ha-Young Oh
- Department of Internal Medicine; Samsung Medical Center; Sungkyunkwan University School of Medicine; Seoul Korea
| | - Cheong-Rae Roh
- Department of Obstetrics and Gynecology; Samsung Medical Center; Sungkyunkwan University School of Medicine; Seoul Korea
| |
Collapse
|
11
|
Pregnancy and orthotopic liver transplantation. Transplant Proc 2014; 45:1966-8. [PMID: 23769084 DOI: 10.1016/j.transproceed.2013.01.013] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2012] [Accepted: 01/15/2013] [Indexed: 11/21/2022]
Abstract
BACKGROUND Sexual and reproductive abnormalities affect up to 50% patients with terminal liver failure. However, these functions recover quickly after orthotopic liver transplantation (OLT). Thus, 80%-90% of OLT women of childbearing age recover menstruation within a few months after transplantation. The aim of our study was to analyze the impact of pregnancy among liver transplant recipients at our center, as well as to analyze the effects of immunosuppression on the fetus. METHODS From April 1986 to April 2011, we performed 1500 OLT in 1341 recipients. Among these recipients, 18 patients (1.2%) become pregnant during the follow-up. RESULTS The most frequent causes of terminal liver failure were as follows: chronic parenchymal disease (n = 9; 50%), cholestatic disease (n = 3; 16.6%), acute liver failure (n = 5; 27.7%), and metabolic disease (n = 1; 5.5%) The average recipient age at the beginning of pregnancy was 21.2 (±7.3) years. Sixteen patients (88%) became pregnant beyond a year after OLT. The 30 pregnancies in our study resulted in the following: newborns alive (NBA; n = 20; 66.6%) abortions (n = 8; 26.6%) or fetal deaths (n = 2; 6%). The most common immunosuppressant used during pregnancy was tacrolimus (75%) followed by cyclosporine (25%). There were no maternal deaths during pregnancy or the postpartum period. DISCUSSION We did not observe significant differences between immunosuppression type and maternal complications, pregnancy duration, and childbirth type. Although pregnancy is potential risk, the literature and our results suggest that at a year or more after OLT it usually is safe and successful.
Collapse
|
12
|
Chinnappa V, Ankichetty S, Angle P, Halpern SH. Chronic kidney disease in pregnancy. Int J Obstet Anesth 2013; 22:223-30. [PMID: 23707038 DOI: 10.1016/j.ijoa.2013.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2012] [Accepted: 03/23/2013] [Indexed: 10/26/2022]
Abstract
Parturients with renal insufficiency or failure present a significant challenge for the anesthesiologist. Impaired renal function compromises fertility and increases both maternal and fetal morbidity and mortality. Close communication amongst medical specialists, including nephrologists, obstetricians, neonatologists and anesthesiologists is required to ensure the safety of mother and child. Pre-existing diseases should be optimized and close surveillance of maternal and fetal condition is required. Kidney function may deteriorate during pregnancy, necessitating early intervention. The goal is to maintain hemodynamic and physiologic stability while the demands of the pregnancy change. Drugs that may adversely affect the fetus, are nephrotoxic or are dependent on renal elimination should be avoided.
Collapse
Affiliation(s)
- V Chinnappa
- Division of Obstetrical Anesthesia, Sunnybrook Health Sciences Centre, Toronto, Canada
| | | | | | | |
Collapse
|
13
|
Controversies in family planning: contraceptive counseling in the solid organ transplant recipient. Contraception 2013; 87:138-42. [DOI: 10.1016/j.contraception.2012.07.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2012] [Accepted: 07/19/2012] [Indexed: 01/05/2023]
|
14
|
Abstract
More women are reporting pregnancy following heart transplantation. Although successful outcomes have been reported for the mother, transplanted heart, and newborn, such pregnancies should be considered high risk. Hypertension, preeclampsia, and infection should be treated. Vaginal delivery is recommended unless cesarean section is obstetrically necessary. Most outcomes are live births, and long-term follow-up of children show most are healthy and developing well. Maternal survival, independent of pregnancy-related events, should be part of prepregnancy counseling.
Collapse
|
15
|
Transplantation: Pregnancy outcomes in kidney recipients: more data are needed. Nat Rev Nephrol 2010; 6:131-2. [PMID: 20186227 DOI: 10.1038/nrneph.2009.232] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
16
|
Mark PB, McCrea IV, Baxter G, McMillan MA. Hydronephrosis in a pregnant renal transplant patient. Transplant Proc 2009; 41:3962-3. [PMID: 19917425 DOI: 10.1016/j.transproceed.2009.05.031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2009] [Accepted: 05/04/2009] [Indexed: 11/30/2022]
Abstract
Although pregnancy can cause hydronephrosis in native kidneys, renal transplant dysfunction during pregnancy due to obstruction is rare. A 22-week pregnant renal transplant patient presented with deteriorating renal function (serum creatinine 5.22 mg/dL from 2.07 mg/dL 3 weeks previously). Ultrasound showed transplant hydronephrosis with the graft compressed between the gravid uterus and liver. Percutaneous nephrostomy was placed with improvement in graft function. The nephrostomy remained in situ for the rest of the pregnancy. The nephrostomy was removed postpartum with no recurrence of hydronephrosis and subsequent transplant biopsy showed no evidence of rejection. The gravid uterus may obstruct a transplanted kidney.
Collapse
Affiliation(s)
- P B Mark
- Renal Unit, Western Infirmary, Glasgow, Scotland.
| | | | | | | |
Collapse
|
17
|
|
18
|
Whitelaw N, Hennessy O, Robertson B, Williams G. Ultrasound in the diagnosis and management of obstructed transplant kidneys during pregnancy. J OBSTET GYNAECOL 2009. [DOI: 10.3109/01443618509079125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
19
|
Gill JS, Zalunardo N, Rose C, Tonelli M. The pregnancy rate and live birth rate in kidney transplant recipients. Am J Transplant 2009; 9:1541-9. [PMID: 19459800 DOI: 10.1111/j.1600-6143.2009.02662.x] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Fertility is one of the potential benefits for women undergoing kidney transplantation; however, population-based information about the likelihood of pregnancy and successful fetal outcome is not available. In this observational study of 16 195 female kidney transplant recipients aged 15-45 years in the United States between 1990 and 2003, we determined the pregnancy rate and live birth rate using Medicare claims data from the first three posttransplant years. The pregnancy rate was 33 per thousand female transplant recipients between 1990 and 2003 and progressively declined from 59 in 1990 to 20 in 2000. The live birth rate between 1990 and 2003 was 19 per thousand female transplant recipients and declined in parallel with the pregnancy rate. Despite a decrease in therapeutic abortions over time, the proportion of pregnancies resulting in fetal loss (45.6%) remained constant during the study due to an increase in spontaneous abortions and other causes of fetal loss. The pregnancy rate in kidney transplant recipients was markedly lower and declined more rapidly than reported in the general American population during the same period. The live birth rate was substantially lower than reported in voluntary registries of transplant recipients, and the proportion of pregnancies resulting in unexpected fetal loss increased over time.
Collapse
Affiliation(s)
- J S Gill
- Department of Medicine, University of British Columbia, Vancouver, Canada.
| | | | | | | |
Collapse
|
20
|
|
21
|
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
|
22
|
Areia A, Galvão A, Pais MSJ, Freitas L, Moura P. Outcome of pregnancy in renal allograft recipients. Arch Gynecol Obstet 2008; 279:273-7. [DOI: 10.1007/s00404-008-0711-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2008] [Accepted: 06/03/2008] [Indexed: 11/28/2022]
|
23
|
|
24
|
Abstract
Reproductive success is a common, expected outcome for male and female recipients of solid-organ transplants. Men can father children, and women can become pregnant and carry the fetus to delivery. There are, however, important maternal and fetal complications that need to be considered to provide optimal care to the mother and her infant. Although pregnancy is common after the transplantation of all solid organs, guidelines for optimal counseling and clinical management are limited. This review discusses information to help the physician counsel the kidney transplant recipient about risks of pregnancy for the mother and the fetus and provides information to help guide treatment of the pregnant transplant recipient.
Collapse
Affiliation(s)
- Dianne B McKay
- Department of Immunology, IMM-1, The Scripps Research Institute, 10550 North Torrey Pines Road, La Jolla, CA 92037, USA.
| | | |
Collapse
|
25
|
Ohler L, Coscia L, Armenti V. Milestones in transplantation. Prog Transplant 2008. [DOI: 10.7182/prtr.18.1.l3465u6050644584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
26
|
Abstract
The patient was admitted to the Boston Lying-in Hospital to await delivery. To avoid any possible trauma to the transplanted kidney as the vertex engaged, it was decided to deliver the patient by cesarean section. This was performed under spinal anesthesia on March 10, 1958, a time arbitrarily regarded as the 41st week of gestation. A normal male infant weighing approximately 3300 grams was delivered.1
Collapse
Affiliation(s)
- Linda Ohler
- Virginia Commonwealth University/Medical College of Virginia, Richmond, VA (LO), National Transplantation Pregnancy Registry, Philadelphia, PA (LC, VA)
| | - Lisa Coscia
- Virginia Commonwealth University/Medical College of Virginia, Richmond, VA (LO), National Transplantation Pregnancy Registry, Philadelphia, PA (LC, VA)
| | - Vincent Armenti
- Virginia Commonwealth University/Medical College of Virginia, Richmond, VA (LO), National Transplantation Pregnancy Registry, Philadelphia, PA (LC, VA)
| |
Collapse
|
27
|
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
|
28
|
|
29
|
|
30
|
Affiliation(s)
- Dianne B McKay
- Department of Immunology, Scripps Research Institute, La Jolla, Calif 92037, USA.
| | | |
Collapse
|
31
|
Yildirim Y, Uslu A. Pregnancy in patients with previous successful renal transplantation. Int J Gynaecol Obstet 2005; 90:198-202. [PMID: 16043182 DOI: 10.1016/j.ijgo.2005.05.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2005] [Revised: 05/16/2005] [Accepted: 05/19/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To evaluate the risk factors affecting pregnancy, perinatal outcomes, and short-term graft condition in women who underwent renal transplantation. METHOD Between May 1998 and January 2005, the histories of 20 pregnancies in 17 renal transplant recipients were reviewed retrospectively at the Ministry of Health Aegean Obstetrics and Gynecology Teaching Hospital. RESULT There were significant associations between high serum creatinine level (>1.5 mg/dL) prior to pregnancy and preterm delivery (P=0.04), and between short interval between transplantation and pregnancy (<2 years) and increased rate of cesarean sections (P=0.04). There were no significant changes in serum creatinine levels during pregnancy in these women, and there were no acute rejection and graft loss during pregnancy or in the 6 months following delivery. CONCLUSION These findings suggest that, although pregnancy does not adversely affect short-term renal allograft function, the rates of obstetric and perinatal complications are increased. Risk factors present before conception are a short interval between renal transplantation and pregnancy and poor renal function.
Collapse
Affiliation(s)
- Y Yildirim
- Ministry of Health Aegean Obstetrics and Gynecology Teaching Hospital, Department of Obstetrics and Gynecology, Izmir, Turkey.
| | | |
Collapse
|
32
|
Kukura S, Viklicky O, Lácha J, Voska L, Honsová E, Teplan V. Recurrence of sarcoidosis in renal allograft during pregnancy. Nephrol Dial Transplant 2004; 19:1640-2. [PMID: 15150362 DOI: 10.1093/ndt/gfh197] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Stefan Kukura
- Department of Nephrology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | | | | | | | | | | |
Collapse
|
33
|
Armenti VT, Moritz MJ, Cardonick EH, Davison JM. Immunosuppression in pregnancy: choices for infant and maternal health. Drugs 2003; 62:2361-75. [PMID: 12396228 DOI: 10.2165/00003495-200262160-00004] [Citation(s) in RCA: 99] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Successful pregnancy outcomes are possible after all types of solid organ transplantation and thousands of successful pregnancies in such women have been reported. As immunosuppressive medications are required to maintain adequate graft and maternal survival, major concerns are the effect of these agents on the fetus and the effect of pregnancy on the well being of mother and graft, against a background of continuing advances and modifications in immunosuppressive therapy. Women should avoid unnecessary medications during pregnancy but clinicians worry most about teratogens; agents (environmental, pharmaceuticals or other chemicals) that cause abnormal development, whether this be an overt structural birth defect or more subtle derangements of embryonic or fetal development. A concern is that any agent or combination of agents and maternal condition(s) may be teratogenic, a risk that is increased in the transplant population. The goal of immunosuppression is to ensure graft and patient survival by preventing acute rejection. Combinations of agents allow for synergistic effects while minimising drug toxicities. No specific combination has been deemed optimal and the effects of more recently available combinations require further study. Although there are known theoretical risks to mother and fetus, successful pregnancies are now the rule in transplant recipients. This is without an apparent increase in the type or incidence of malformations in the newborns, and usually with no evidence of graft dysfunction and/or irreversible deterioration either related to prepregnancy graft problems or unpredictable gestational factors. For immunosuppression, what is best for the mother and her survival should ensure the best outcome for the fetus and, although no specific malformation pattern has been reported to date, there are some interesting trends worthy of continued analyses. A balance of good maternal and graft outcome with the lowest risk of fetal toxicity must be the goal of management.
Collapse
Affiliation(s)
- Vincent T Armenti
- Department of Surgery, Thomas Jefferson University, Philadelphia, PA, USA.
| | | | | | | |
Collapse
|
34
|
Armenti VT, Moritz MJ, Coscia LA, Philips LZ. Autoimmune and pregnancy complications in the daughter of a kidney transplant patient. Transplantation 2002; 73:677-8. [PMID: 11907410 DOI: 10.1097/00007890-200203150-00004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Vincent T Armenti
- Department of Surgery, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | | | | | | |
Collapse
|
35
|
Kuvacić I, Sprem M, Skrablin S, Kalafatić D, Bubić-Filipi L. Pregnancy outcome in renal transplant recipients. Int J Gynaecol Obstet 2000; 70:313-7. [PMID: 10967164 DOI: 10.1016/s0020-7292(00)00244-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To correlate pregnancy outcome with complications in pregnancy and transplantation-to-pregnancy interval in renal transplant recipients in Croatia. METHOD Data on 23 pregnancies after prepregnancy stabilization of blood pressure and normalization of graft function were retrospectively analyzed. RESULT The mean interval between transplantation and conception was 3.1 years. Primary renal disease was chronic glomerulonephritis in 7, chronic pyelonephritis in 7 and agenesis of right kidney and stenosis of left renal artery in 1 patient. There were 10 term and 5 preterm deliveries, 6 induced and 2 spontaneous abortions. The mean gestational age was 38.1 weeks and the mean newborn birthweight was 3015 g. The prematurity rate was 21.7%. Patients with arterial hypertension in pregnancy, elevated serum creatinine level and bacteriuria, as well as those with conception occurring less than 2 years after transplantation, had a higher rate of therapeutic and spontaneous abortions, preterm deliveries and low birth weight infants. CONCLUSION The interval between transplantation and conception, as well as allograft function during pregnancy, seem to be of great importance for successful obstetric outcome in renal transplant patients.
Collapse
Affiliation(s)
- I Kuvacić
- Department of Gynecology and Obstetrics, Zagreb University School of Medicine, Zagreb, Croatia
| | | | | | | | | |
Collapse
|
36
|
Armenti VT, Moritz MJ, Jarrell BE, Davison JM. Pregnancy after transplantation. Transplant Rev (Orlando) 2000. [DOI: 10.1053/trre.2000.7152] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
37
|
Ben Hamida F, Ben Abdallah T, Barbouch S, Laabidi J, Abderrahim E, Goucha R, Hedri H, el Younsi F, Ben Moussa F, Kheder MA, Ben Maïz H. Four successful pregnancies following kidney transplantation. Transplant Proc 1999; 31:3146-7. [PMID: 10616416 DOI: 10.1016/s0041-1345(99)00759-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- F Ben Hamida
- Department of Nephrology and Internal Medicine, Charles Nicolle Hospital, Tunis, Tunisia
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
38
|
Armenti VT, Moritz MJ, Davison JM. Drug safety issues in pregnancy following transplantation and immunosuppression: effects and outcomes. Drug Saf 1998; 19:219-32. [PMID: 9747668 DOI: 10.2165/00002018-199819030-00005] [Citation(s) in RCA: 110] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Successful pregnancy outcomes are possible after solid organ transplantation. While there are risks to mother and fetus, there has not been an increased incidence of malformations noted in the newborn of the transplant recipient. It is essential that there is closely coordinated care that involves the transplant team and an obstetrician in order to obtain a favourable outcome. Current data from the literature, as well as from reports from the National Transplantation Pregnancy Registry (NTPR), support the concept that immunosuppression be maintained at appropriate levels during pregnancy. At present, most immunosuppressive maintenance regimens include combination therapy, usually cyclosporin or tacrolimus based. Most female transplant recipients will be receiving maintenance therapy prior to and during pregnancy. For some agents, including monoclonal antibodies and mycophenolate mofetil, there is either no animal reproductive information or there are concerns about reproductive safety. The optimal (lowest risk) transplant recipient can be defined by pre-conception criteria which include good transplant graft function, no evidence of rejection, minimum 1 to 2 years post-transplant and no or well controlled hypertension. For these women pregnancy generally proceeds without significant adverse effects on mother and child. It is of note that the epidemiological data available to date on azathioprine-based regimens are favourable in the setting of a category D agent (i.e. one that can cause fetal harm). Thus, there is still much to learn regarding potential toxicities of immunosuppressive agents. The effect of improved immunosuppressive regimens which use newer or more potent (and potentially more toxic) agents will require further study.
Collapse
Affiliation(s)
- V T Armenti
- Department of Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | | | | |
Collapse
|
39
|
Armenti VT, Moritz MJ, Davison JM. Medical management of the pregnant transplant recipient. ADVANCES IN RENAL REPLACEMENT THERAPY 1998; 5:14-23. [PMID: 9477211 DOI: 10.1016/s1073-4449(98)70010-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Retrospective analyses of pregnancies in female renal transplant recipients including case reports, center reports, and questionnaire surveys have, for the most part, reached similar conclusions. In the presence of adequate, stable graft function, these high-risk pregnancies are generally well tolerated, but the majority of the liveborn outcomes are premature and many of the newborns are low birthweight. Obstetrical complications such as preeclampsia and cesarean section occur in a significant proportion of cases. With improvements in methods of data acquisition and computer technology, the aim for the future must be enhanced communication between transplant centers on a prospective basis, perhaps comparing cases with patient profiles derived from analyzed databases such as the National Transplantation Pregnancy Registry (NTPR). Continued efforts to identify prepregnancy risk factors as well as optimal antenatal management strategies will help to further improve pregnancy outcomes in this population. Discussed in this review are reports from the literature as well as current data from the NTPR focusing on the medical management of pregnancy in the renal transplant recipient.
Collapse
Affiliation(s)
- V T Armenti
- National Transplantation Pregnancy Registry, Thomas Jefferson University, Philadelphia, PA, USA
| | | | | |
Collapse
|
40
|
Morita K, Seki T, Shinojima H, Tabata T, Chikaraishi T, Tanda K, Nonomura K, Koyanagi T, Hirano T, Sakakibara N, Kishida T, Fujimoto S, Kakizaki K. Parturition in six renal allograft recipients. Int J Urol 1996; 3:54-7. [PMID: 8646600 DOI: 10.1111/j.1442-2042.1996.tb00630.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Between 1983 and 1994, we studied renal function and neonatal conditions for eight pregnancies and births to six women who had received renal transplants in order to assess the effect of an allograft on pregnancy and its outcome. The gestation period was 34 to 39 weeks (mean 36 weeks and 4 days), and four pregnancies ended before term. All eight babies were delivered by cesarean section. Intrauterine growth retardation (IUGR) was found in both babies of one woman who had been treated with conventional (without cyclosporin) immunosuppression. The serum creatinine level did not change during gestation in any of the women but was elevated after delivery in four. Four mothers suffered from proteinuria (25-364 mg/dl) during gestation, but the proteinuria disappeared after delivery in all but one case. The one exception, persistent proteinuria of 100-200 mg/dl, was assumed to result from the recurrence of the original renal disease (lgA nephropathy). The reduction of creatinine clearance and hydronephrosis of one graft noted during gestation were later reversed. None of the eight babies (four females and four males) was congenitally malformed, and their Apar scores were 6 to 9 (median 8). They are now 3 months to 11 years old, and seven of them are healthy and show good growth. One of the two IUGR babies has not grown well; her weight and height are more than 1 SD below the mean for her age, and she is mentally retarded and suffers from muscle weakness. Compared with dialysis patients, female renal allograft recipient have a better quality of life because they can safely deliver a child if they observe the criteria for pregnancy established for renal allogaft recipients.
Collapse
Affiliation(s)
- K Morita
- Department of Urology, Hokkaido University, Sapporo, Japan
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
41
|
To WW, Lam KS, Chan YM. Pregnancy following renal transplantation: the experience in Hong Kong. JOURNAL OF OBSTETRICS AND GYNAECOLOGY (TOKYO, JAPAN) 1995; 21:263-7. [PMID: 8590363 DOI: 10.1111/j.1447-0756.1995.tb01007.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVE To assess the outcome of pregnancies occurring after renal transplantation, and to review the factors conductive to a favourable outcome. METHOD A retrospective review of 8 pregnancies occurring after renal transplantation from 1988 to 1992 in a tertiary referral centre in Hong Kong. RESULT A very high successful pregnancy rate was achieved with minimal maternal and perinatal morbidity in the cases reviewed. CONCLUSION Good prepregnancy counselling and stringent criteria for pregnancy assessment appears to be crucial factors for a favourable pregnancy outcome.
Collapse
Affiliation(s)
- W W To
- Department of Obstetrics and Gynaecology, University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong
| | | | | |
Collapse
|
42
|
Ogasawara M, Aoki K, Hayashi Y. A prospective study on pregnancy risk of antiphospholipid antibodies in association with systemic lupus erythematosus. J Reprod Immunol 1995; 28:159-64. [PMID: 7769581 DOI: 10.1016/0165-0378(94)00912-q] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
This prospective study is an attempt to address the issues of whether or not antiphospholipid antibodies (aPL) constitute a significant risk factor for pregnancy in individuals with systemic lupus erythematosus (SLE) and whether or not combination therapy of high-dose prednisolone (PSL) and low-dose acetylsalicylic acid (ASA) offers efficient control. Antibodies against six phospholipids were measured in sera of patients with stable SLE who had no severe complications before pregnancy, and were followed up during subsequent pregnancies. Four of 12 patients with SLE demonstrated aPL-positivity. Six of 8 patients without aPL had appropriate-for-date (AFD) live babies, the remaining two suffering intrauterine fetal death (IUFD) in the first trimester, one having a chromosome abnormality. Two aPL-positive patients treated only with 5-15 mg/day PSL during pregnancy ended in IUFD in the second trimester. In contrast, the other two patients treated with high-dose PSL and low-dose ASA each had AFD live babies at 38 weeks gestation. The results suggest that APL is a crucial risk factor in pregnancy with stable SLE. Combination therapy of high-dose PSL and low-dose ASA may enable aPL-positive patients with SLE to have AFD live babies.
Collapse
Affiliation(s)
- M Ogasawara
- Department of Obstetrics and Gynecology, Nagoya City University Medical School, Japan
| | | | | |
Collapse
|
43
|
Abstract
Pregnancy in renal allograft recipients is associated with hyperfiltration with the potential for glomerular damage and adverse effects on long-term graft prognosis. We have undertaken a case-controlled study of posttransplant follow-up for a mean of 12 years (range, 4 to 23) in 36 female renal allograft recipients, 18 who became pregnant and 18 controls (matched to underlying disease and renal function) who did not. Assessments included plasma creatinine (PCr), glomerular filtration rate (GFR) by infusion clearance of inulin (Cin), mean arterial pressure (MAP), and documentation of antihypertensive therapy. By the end of follow-up, PCr in the pregnancy group (112 +/- 73 mumol/L [1.26 +/- 0.83 mg/dL]) and controls (127 +/- 52 mumol/L [1.44 +/- 0.59 mg/dL]) had increased by 19% and 8%, respectively, and GFR in the pregnancy group (58 +/- 29 mL/min) and controls (56 +/- 32 mL/min) had decreased by 18% and 7%, respectively. Graft loss or chronic rejection occurred in two patients in each group and there was a death in the pregnancy group 9 years after the second of two successful pregnancies. MAP in the pregnancy group (96 +/- 12 mm Hg) had decreased by 1%, and in the controls (101 +/- 9 mm Hg) had increased by 5%. Two patients in the index group and three in the control group commenced antihypertensive therapy during follow-up. There was, therefore, no evidence of an adverse effect of pregnancy in renal allograft recipients on long-term renal function or development of hypertension.
Collapse
Affiliation(s)
- S N Sturgiss
- Department of Obstetrics and Gynecology, Princess Mary Maternity Hospital, Newcastle-upon-Tyne, UK
| | | |
Collapse
|
44
|
Berardinelli L, Dallatana R, Beretta C, Raiteri M, Tonello G, Quaglia F, Vegeto A. Pregnancy in kidney recipients under cyclosporine. Transpl Int 1992; 5 Suppl 1:S480-1. [PMID: 14621852 DOI: 10.1007/978-3-642-77423-2_140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
About 1 of every 50 women of child-bearing age who have a functioning kidney transplant become pregnant. Successful pregnancies following kidney allotransplantation with conventional immunosuppressive treatment are well described, and there is no evidence of abnormalities in the infants born. The use of cyclosporine (CSA) means new problems for the pregnant women and the fetus: the risk of congenital abnormalities, fetal growth retardation, hepato- and nephrotoxicity. We report the experience of 16 pregnancies in 16 of our kidney transplant patients, of which 7 were treated with CSA.
Collapse
Affiliation(s)
- L Berardinelli
- Department of Vascular Surgery and Kidney Transplantation, Policlinico University Hospital, Milan, Italy
| | | | | | | | | | | | | |
Collapse
|
45
|
Abstract
Women on regular dialysis are usually infertile, but contraception should not be neglected. Pregnancy is invariably complicated and poses excessive risks, with an uncertain and low chance of success. Even when therapeutic abortion is excluded, the live birth outcome at best is 19%. Renal transplantation usually reverses abnormal reproductive function and comprehensive pre-pregnancy counseling is essential, with discussion of all implications, including the harsh realities of long-term maternal survival. In this survey of 2,309 pregnancies in 1,594 women, therapeutic abortion was undertaken in 27% of conceptions and the spontaneous abortion rate was 13%. Of the conceptions that continued beyond the first trimester, 92% ended successfully. In most, renal function was augmented in pregnancy, with transient deterioration in late pregnancy (with or without proteinuria). Permanent renal impairment occurred in 15% of pregnancies. There was a 30% chance of developing hypertension, preeclampsia or both. Preterm delivery occurred in 50%, and intrauterine growth retardation in 25% of pregnancies. Despite its pelvic location, the transplanted kidney rarely produced dystocia and was not injured during vaginal delivery. Cesarean section should be reserved for obstetric reasons only. Neonatal complications include respiratory distress syndrome, leukopenia, thrombocytopenia, adrenocortical insufficiency, and infection. No predominant or frequent developmental abnormalities have been described and data on infancy and childhood are encouraging. For the future more work is needed to improve pre-pregnancy assessment criteria, to understand the mechanisms of gestational renal dysfunction and proteinuria, to assess the side effects and implications of immunosuppression in pregnancy, and to elucidate the remote effects of pregnancy on both renal prognosis and the offspring.
Collapse
|
46
|
Bung P, Molitor D. Pregnancy and postpartum after kidney transplantation and cyclosporin therapy--review of the literature adding a new case. J Perinat Med 1991; 19:397-401. [PMID: 1804951 DOI: 10.1515/jpme.1991.19.5.397] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The number of pregnancies after renal transplantation and immunosuppression is relative low. Since the introduction of a most effective medication, Cyclosporin A, there is not only an increasing improvement of the transplantation results, but there are also more reports on successfully concluded pregnancies. This report pertains to a 26-year old primigravida, whose pregnancy progressed without severe complications until the 33rd week of gestation. Then a sudden and rapidly worsening preeclampsia led to admission and delivery. The postoperative period was complicated by a severe septical shock. The literature is reviewed. Problems following pregnancy after kidney transplantation and triple immunotherapy with Cyclosporin A treatment are pointed out.
Collapse
Affiliation(s)
- P Bung
- Department of Gynaecology and Obstetrics, University of Bonn, Fed. Rep. of Germany
| | | |
Collapse
|
47
|
Neinstein LS, Katz B. Contraceptive use in the chronically ill adolescent female. Part II. JOURNAL OF ADOLESCENT HEALTH CARE : OFFICIAL PUBLICATION OF THE SOCIETY FOR ADOLESCENT MEDICINE 1986; 7:350-60. [PMID: 3531120 DOI: 10.1016/s0197-0070(86)80165-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
|
48
|
Birkeland SA, Kristoffersen K. Immune monitoring of pregnancy in renal transplanted patients. AMERICAN JOURNAL OF REPRODUCTIVE IMMUNOLOGY : AJRI : OFFICIAL JOURNAL OF THE AMERICAN SOCIETY FOR THE IMMUNOLOGY OF REPRODUCTION AND THE INTERNATIONAL COORDINATION COMMITTEE FOR IMMUNOLOGY OF REPRODUCTION 1984; 5:72-7. [PMID: 6372526 DOI: 10.1111/j.1600-0897.1984.tb00292.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Immune studies were performed in eight pregnancies occurring after renal transplantation (tx). In three cases a regular, long-term immune monitoring before, during, and after the pregnancy was possible. The results showed 1) no changes concerning OKT 3, 4, 8, and SMIg-defined T- and B-lymphocyte subsets in the mothers: 2) a higher level of spontaneous E- and normal E-rosette-defined T-subsets in the mothers rejecting their allografts; 3) a stronger response to mitogen and antigen stimulation and a stronger mixed lymphocyte culture (MLC) response towards the infants also in those rejecting their grafts; 4) the offspring of the transplanted mothers showed a weaker immune responder state compared with the offspring of six age-matched normal mothers.
Collapse
|
49
|
Abstract
The results of a series of 6 pregnancies (including 1 set of twins) in renal transplant patients are presented with a review of the relevant literature. There were no fetal anomalies or deaths, or episodes of renal compromise or graft rejection. The important complications were hypertension (4), prematurity (4) and fetal growth retardation (2).
Collapse
|
50
|
Whetham JC, Cardella C, Harding M. Effect of pregnancy on graft function and graft survival in renal cadaver transplant patients. Am J Obstet Gynecol 1983; 145:193-7. [PMID: 6336899 DOI: 10.1016/0002-9378(83)90490-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Variable experience is documented for pregnancy in renal transplant patients. Furthermore, little information is available that compares graft function and graft survival of cadaver transplant patients who undergo pregnancy with those of a similar group of patients who do not undergo pregnancy. From 1970 to 1979, 30 patients of childbearing age were identified who were first-time recipients of cadaver-donor kidneys. Long-term follow-up was from 32 to 136 months. Five patients have undergone seven pregnancies that resulted in six viable infants and one therapeutic termination. Pregnancy complications included severe preeclampsia, spontaneous premature rupture of membranes, and proteinuria. One infant was small for gestational age. There were no neonatal problems, and no congenital anomalies. Rejection episodes were more common in the postpartum than in the antepartum period (four of six versus one of six). Chronic rejection that led to graft loss occurred in two patients. Ten patients who did not undergo pregnancy were identified for comparison of graft function and graft survival. Late graft rejections occurred in four patients, two of whom eventually suffered graft loss. Survival rates of the grafts by actuarial analysis for the two groups were not significantly different.
Collapse
|