1
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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.
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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
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2
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Szpotanska-Sikorska M, Knap-Wielgus W, Jasak K, Ajdacka-Matczuk U, Stelmach D, Korzeb B, Jabiry-Zieniewicz Z. Family Planning and Assessment of the Frequency of Exposure to Drugs Contraindicated in Pregnancies After Kidney or Liver Transplantation: A Retrospective Cross-Sectional Study. Transplant Proc 2024:S0041-1345(24)00181-7. [PMID: 38735765 DOI: 10.1016/j.transproceed.2024.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Revised: 03/25/2024] [Accepted: 03/26/2024] [Indexed: 05/14/2024]
Abstract
BACKGROUND A successful organ transplant restores gonadal function in the first months after surgery, which leads to the normalization of menstrual cycles and increases the chance of pregnancy. Recipients of organ transplants should effectively prevent pregnancy for a minimum of 1 year and optimally up to 2 years after surgery. This study aimed to evaluate the incidence of unplanned pregnancies in female organ transplant recipients METHODS: A cross-sectional, single-center survey study of 46 pregnant organ recipients who were hospitalized at the Department of Obstetrics and Gynaecology. RESULTS In the post-transplant period, we recorded 46 patients, including 27 kidney recipients (59%) and 19 liver recipients (41%). Forty-nine respondents reported 66 pregnancies, of which 52 ended in live births (79%). Twenty of the pregnancies were not planned. In that group, 16 pregnancies ended in labor, 2 in miscarriage, and 2 in termination. In 10 of the unplanned pregnancies, the women were treated with potentially teratogenic drugs in the first trimester. The duration of the pregnancy was shorter in the group of women who had not planned their pregnancies and had conceived during potentially teratogenic therapy (30.66 ± 3.61 weeks) than in women who had planned their pregnancies (34.95 ± 4 weeks, P < .0215). CONCLUSION Women after organ transplantation are at high risk for pregnancy complications. Therefore, conception planning is an important element of post-transplant care, especially because the percentage of unplanned pregnancies in this group remains high despite the use of potentially teratogenic drugs.
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Affiliation(s)
| | | | - Kamil Jasak
- 1st Department of Obstetrics and Gynecology, Medical University of Warsaw, Poland
| | | | - Daria Stelmach
- 1st Department of Obstetrics and Gynecology, Medical University of Warsaw, Poland
| | - Bartosz Korzeb
- 1st Department of Obstetrics and Gynecology, Medical University of Warsaw, Poland
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3
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Nikzad N, Fisher AR, Pillai A, Targownik LE, Te HS, Aronsohn A, Paul S. Considerations in gender-affirming hormone therapy in transgender and gender diverse patients undergoing liver transplantation. Am J Transplant 2024:S1600-6135(24)00296-X. [PMID: 38729612 DOI: 10.1016/j.ajt.2024.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 04/26/2024] [Accepted: 05/06/2024] [Indexed: 05/12/2024]
Abstract
Liver transplantation is lifesaving for patients with end-stage liver disease. Similar to the role of transplantation for patients with end-stage liver disease, gender-affirming hormone therapy (GAHT) can be lifesaving for transgender and gender diverse (TGGD) patients who experience gender dysphoria. However, management of such hormone therapy during the perioperative period is unknown and without clear guidelines. Profound strides can be made in improving care for TGGD patients through gender-affirming care and appropriate management of GAHT in liver transplantation. In this article, we call for the transplant community to acknowledge the integral role of GAHT in the care of TGGD liver transplant candidates and recipients. We review the current literature and describe how the transplant community is ethically obligated to address this health care gap. We suggest tangible steps that clinicians may take to improve health outcomes for this minoritized patient population.
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Affiliation(s)
- Newsha Nikzad
- Department of Internal Medicine, University of Chicago Medicine, Chicago, Illinois, USA
| | - Andrew R Fisher
- Department of Obstetrics and Gynecology, University of Chicago Medicine, Chicago, Illinois, USA
| | - Anjana Pillai
- Department of Gastroenterology, Hepatology & Nutrition, Center for Liver Disease, University of Chicago Medicine, Chicago, Illinois, USA
| | - Laura E Targownik
- Department of Gastroenterology and Hepatology, University of Toronto, Toronto, Ontario, Canada
| | - Helen S Te
- Department of Gastroenterology, Hepatology & Nutrition, Center for Liver Disease, University of Chicago Medicine, Chicago, Illinois, USA
| | - Andrew Aronsohn
- Department of Gastroenterology, Hepatology & Nutrition, Center for Liver Disease, University of Chicago Medicine, Chicago, Illinois, USA
| | - Sonali Paul
- Department of Gastroenterology, Hepatology & Nutrition, Center for Liver Disease, University of Chicago Medicine, Chicago, Illinois, USA.
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4
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Garriga M, Zhang G, Sarkar M. Contraception in patients with liver disease and liver transplant. Clin Liver Dis (Hoboken) 2024; 23:e0104. [PMID: 38379765 PMCID: PMC10878548 DOI: 10.1097/cld.0000000000000104] [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: 08/07/2023] [Accepted: 09/30/2023] [Indexed: 02/22/2024] Open
Abstract
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Affiliation(s)
- Meera Garriga
- Department of Medicine University of California, San Francisco, San Francisco, CA, USA
| | - Grace Zhang
- Department of Medicine University of California, San Francisco, San Francisco, CA, USA
| | - Monika Sarkar
- Division of GI/Hepatology, University of California, San Francisco, San Francisco, CA, USA
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5
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Livingstone J, Raveh Y, Souki F, Shatz V, Shah R, Ibrahim T, Shuman M, Beduschi T, Vianna R, Alvarez R, Nicolau-Raducu R. Multivisceral Transplant in a Patient With Portopulmonary Hypertension: A Case Report. Transplant Proc 2022; 54:1664-1670. [PMID: 35914967 DOI: 10.1016/j.transproceed.2022.03.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 03/14/2022] [Indexed: 11/18/2022]
Abstract
Portopulmonary hypertension, a type of pulmonary arterial hypertension in the setting of cirrhotic or noncirrhotic portal hypertension, is associated with elevated morbidity and mortality during and after transplantation. Uncontrolled portopulmonary hypertension may prevent or delay listing for transplant candidates, and the prognosis without treatment and ultimately transplant is extremely poor. We present a 29-year-old White woman, who had a post-liver transplant at infancy due to biliary atresia. Later on, she developed extensive portal vein thrombosis and portopulmonary hypertension and underwent a multivisceral transplant (liver, stomach, pancreaticoduodenal complex, and small and large intestine). Preoperative mean pulmonary artery pressure was <30 mm Hg with a pulmonary vascular resistance of <300 dynes.s/cm5 on oral sildenafil and intravenous epoprostenol. Intraoperatively, management required comprehensive transfusion protocols, a careful balance between correcting blood loss and preventing thrombosis. Intravenous epoprostenol, sildenafil, milrinone, and inhaled nitric oxide were used to reduce elevated mean pulmonary artery pressure and right ventricular strain associated with vascular clamping, reperfusion, and massive fluid shifts. Nitric oxide and epoprostenol use unleashed antiplatelet effects on a patient already susceptible to coagulopathy. A multimodal and multidisciplinary approach continued throughout the surgery and in the postoperative period, which led to a successful outcome.
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Affiliation(s)
- J Livingstone
- Department of Anesthesia, University of Miami/Jackson Memorial Hospital, Miami, Florida
| | - Y Raveh
- Department of Anesthesia, University of Miami/Jackson Memorial Hospital, Miami, Florida
| | - F Souki
- Department of Anesthesia, University of Miami/Jackson Memorial Hospital, Miami, Florida
| | - V Shatz
- Department of Anesthesia, University of Miami/Jackson Memorial Hospital, Miami, Florida
| | - R Shah
- Miami Transplant Institute, University of Miami/Jackson Memorial Hospital, Miami, Florida; Department of Surgery, University of Miami/Jackson Memorial Hospital, Miami, Florida
| | - T Ibrahim
- Department of Surgery, University of Miami/Jackson Memorial Hospital, Miami, Florida
| | - M Shuman
- Department of Anesthesia, University of Miami/Jackson Memorial Hospital, Miami, Florida
| | - T Beduschi
- Miami Transplant Institute, University of Miami/Jackson Memorial Hospital, Miami, Florida; Department of Surgery, University of Miami/Jackson Memorial Hospital, Miami, Florida
| | - R Vianna
- Miami Transplant Institute, University of Miami/Jackson Memorial Hospital, Miami, Florida; Department of Surgery, University of Miami/Jackson Memorial Hospital, Miami, Florida
| | - R Alvarez
- Department of Medicine, University of Miami/Jackson Memorial Hospital, Miami, Florida
| | - R Nicolau-Raducu
- Department of Anesthesia, University of Miami/Jackson Memorial Hospital, Miami, Florida.
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6
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Ardura MI, Coscia LA, Meyers MR. Promoting safe sexual practices and sexual health maintenance in pediatric and young adult solid organ transplant recipients. Pediatr Transplant 2021; 25:e13949. [PMID: 33491268 DOI: 10.1111/petr.13949] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 12/01/2020] [Accepted: 12/02/2020] [Indexed: 12/17/2022]
Abstract
The majority of Americans make their sexual debut during their adolescent years. Preventing pregnancy and STI during this period is vital to ensuring health and safety. As survival has improved after pediatric SOT, chronically immunosuppressed adolescents seek guidance in their medical home on matters of sexual health. Transplant practitioners often do not feel equipped to fully address these needs. This review serves as an introductory sexual preventive care resource for adolescent and young adult (AYA) SOT recipients. First, we review data on safety, efficacy, and use of contraceptive options currently available for transplant recipients with child-bearing potential. Then, we suggest a personalized sexual health discussion focusing on the diagnosis and prevention of STIs in adolescent and young adult transplant recipients. Finally, we present recommendations for STI screening of asymptomatic patients, use of index of suspicion and diagnostic testing in symptomatic patients, and opportunities to optimize STI prevention strategies. Data compiled from studies of adult SOT recipients, general population studies, and published guidelines are often extrapolated for use, as limited data exist in AYA SOT recipients. This informational dearth underscores the need for future research to better characterize the unique needs of AYA SOT recipients.
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Affiliation(s)
- Monica I Ardura
- Pediatric Infectious Diseases & Host Defense, Nationwide Children's Hospital, The Ohio State University, Columbus, OH, USA
| | - Lisa A Coscia
- Transplant Pregnancy Registry International, Philadelphia, PA, USA
| | - Melissa R Meyers
- Pediatric Nephrology, Children's National Health System, Washington, DC, USA
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7
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Sarkar M, Brady CW, Fleckenstein J, Forde KA, Khungar V, Molleston JP, Afshar Y, Terrault NA. Reproductive Health and Liver Disease: Practice Guidance by the American Association for the Study of Liver Diseases. Hepatology 2021; 73:318-365. [PMID: 32946672 DOI: 10.1002/hep.31559] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 09/08/2020] [Indexed: 12/11/2022]
Affiliation(s)
- Monika Sarkar
- University of California, San Francisco, San Francisco, CA
| | | | | | | | | | - Jean P Molleston
- Indiana University and Riley Hospital for Children, Indianapolis, IN
| | - Yalda Afshar
- University of California, Los Angeles, Los Angeles, CA
| | - Norah A Terrault
- Keck School of Medicine, University of Southern California, Los Angeles, CA
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8
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Choudhary NS, Saraf N, Saigal S, Soin AS. Long-term Management of the Adult Liver Transplantation Recipients. J Clin Exp Hepatol 2021; 11:239-253. [PMID: 33746450 PMCID: PMC7953009 DOI: 10.1016/j.jceh.2020.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 06/14/2020] [Indexed: 12/12/2022] Open
Abstract
The survival of liver transplantation (LT) recipients has been improved remarkably in short-term. The major causes of mortality in long-term include nonimmunological causes such as cardiovascular, de novo malignancy, chronic kidney disease, and recurrence of primary disease. Rejection-related mortality is rare in the long-term after LT. We discuss nonrejection causes of long-term morbidity/mortality, risk factors, and management strategies in LT recipients. In addition, we discuss osteoporosis, contraception, and pregnancy in LT recipients.
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Key Words
- AIH, autoimmune hepatitis
- BMI, body mass index
- CKD, chronic kidney disease
- CNI, calcineurin inhibitors
- CVD, cardiovascular disease
- DDLT, deceased donor liver transplantation
- DM, diabetes mellitus
- DNM, de novo malignancy
- HCV, hepatitis C virus
- HR, hazard ratio
- IUCD, Intrauterine contraceptive devices
- LDLT, living donor liver transplantation
- LT, liver transplantation
- MDRD, Modification of Diet in Renal Disease
- MMF, mycophenolate
- MS, metabolic syndrome
- NAFLD, nonalcoholic fatty liver disease
- NASH, nonalcoholic steatohepatitis
- OR, odds ratio
- PBC, primary biliary cholangitis
- PSC, primary sclerosing cholangitis
- PTDM, posttransplantation diabetes mellitus
- PTMS, posttransplantation metabolic syndrome
- SVR, sustained virological response
- cardiovascular disease
- de novo malignancy
- eGFR, estimated glomerular filtration rate
- mTORi, Mammalian target of rapamycin inhibitors
- osteoporosis
- pregnancy
- recurrence
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Affiliation(s)
| | - Neeraj Saraf
- Address for correspondence: Dr Neeraj Saraf, Medanta Institute of Liver Transplantation and Regenerative Medicine, Medanta The Medicity Hospital, Sector 38, Gurgaon, Delhi (NCR), India.
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9
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Ziogas IA, Hayat MH, Tsoulfas G. Obstetrical and gynecologic challenges in the liver transplant patient. World J Transplant 2020; 10:320-329. [PMID: 33312893 PMCID: PMC7708880 DOI: 10.5500/wjt.v10.i11.320] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 10/05/2020] [Accepted: 10/20/2020] [Indexed: 02/06/2023] Open
Abstract
An increasing number of childbearing agewomen undergo liver transplantation (LT) in the United States. Transplantation in this patient subgroup poses a significant challenge regarding the plans for future fertility, particularly in terms of immunosuppression and optimal timing of conception. Intrapartum LT is only rarely performed as the outcome is commonly dismal for the mother or more commonly the fetus. On the other hand, the outcomes of pregnancy in LT recipients are favorable, and children born to LT recipients are relatively healthy. Counseling on pregnancy should start before LT and continue after LT up until pregnancy, while all pregnant LT recipients must be managed by amultidisciplinary team, including both an obstetrician and a transplant hepatologist. Additionally, an interval of at least 1-2 years after successful LT is recommended before considering pregnancy. Pregnancy-induced hypertension, pre-eclampsia, and gestational diabetes mellitus are reported more commonly during the pregnancies of LT recipients than in the pregnancies of non-transplant patients. As adverse fetal outcomes, such asmiscarriage, abortion, stillbirth, or ectopic pregnancy, may occur more often than in the non-transplant population, early planning or delivery either through a planned induction of labor or cesarean section is critical to minimize the risk of complications. No significant long-term physical or phycological abnormalities have been reported in children born to LT recipients.
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Affiliation(s)
- Ioannis A Ziogas
- Medical School, Aristotle University of Thessaloniki, Thessaloniki 54124, Greece
| | - Muhammad H Hayat
- Department of Medicine, Division of Gastroenterology, Hepatology and Nutrition, Vanderbilt University Medical Center, Nashville, TN 37212, United States
| | - Georgios Tsoulfas
- Department of Surgery, Papageorgiou University Hospital, Aristotle University of Thessaloniki, Thessaloniki 54622, Greece
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10
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Rahim MN, Long L, Penna L, Williamson C, Kametas NA, Nicolaides KH, Heneghan MA. Pregnancy in Liver Transplantation. Liver Transpl 2020; 26:564-581. [PMID: 31950556 DOI: 10.1002/lt.25717] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Accepted: 12/26/2019] [Indexed: 02/06/2023]
Abstract
Pregnancy after liver transplantation (LT) is increasingly common and is a frequent scenario that transplant physicians, obstetricians, and midwives encounter. This review summarizes the key issues surrounding preconception, pregnancy-related outcomes, immunosuppression, and breastfeeding in female LT recipients. Prepregnancy counseling in these patients should include recommendations to delay conception for at least 1-2 years after LT and discussions about effective methods of contraception. Female LT recipients are generally recommended to continue immunosuppression during pregnancy to prevent allograft rejection; however, individual regimens may need to be altered. Although pregnancy outcomes are overall favorable, there is an increased risk of maternal and fetal complications. Pregnancy in this cohort remains high risk and should be managed vigilantly in a multidisciplinary setting. We aim to review the available evidence from national registries, population-based studies, and case series and to provide recommendations for attending clinicians.
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Affiliation(s)
- Mussarat N Rahim
- Institute of Liver Studies, King's College Hospital, London, United Kingdom
| | - Lisa Long
- Department of Obstetrics, King's College Hospital, London, United Kingdom
| | - Leonie Penna
- Department of Obstetrics, King's College Hospital, London, United Kingdom
| | | | - Nikos A Kametas
- Fetal Medicine Research Unit, King's College Hospital, London, United Kingdom
| | - Kypros H Nicolaides
- Fetal Medicine Research Unit, King's College Hospital, London, United Kingdom
| | - Michael A Heneghan
- Institute of Liver Studies, King's College Hospital, London, United Kingdom
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11
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Milić S, Tatalović T, Mikolašević I. Pre-existing liver disease in pregnancy: Cirrhosis, autoimmune hepatitis and liver transplantation. Best Pract Res Clin Gastroenterol 2020; 44-45:101668. [PMID: 32359683 DOI: 10.1016/j.bpg.2020.101668] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 01/22/2020] [Accepted: 02/18/2020] [Indexed: 01/31/2023]
Abstract
Liver disease during pregnancy is one of the least studied topics, but it links the interests of hepatologists, gynaecologists and family physicians. Approximately 3% of pregnant woman experience some type of liver disease. Liver disease can occur as a result of pregnancy, before pregnancy and coincidence-related during pregnancy. Pregnancy in women with pre-existing liver disease is essential that the clinicians are familiar with this disorder so they can respond promptly and appropriately in all of these situations. So, because of the complications for both mother and child, it is important that liver disease is recognized in a timely manner to avoid undesirable outcomes.
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Affiliation(s)
- Sandra Milić
- School of Medicine, University of Rijeka, Rijeka, Croatia; Department of Gastroenterology, University Hospital Center Rijeka, Rijeka, Croatia.
| | | | - Ivana Mikolašević
- School of Medicine, University of Rijeka, Rijeka, Croatia; Department of Gastroenterology, University Hospital Center Rijeka, Rijeka, Croatia.
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12
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Abstract
PURPOSE OF REVIEW Long-term survival is now the rule rather than the exception for infants and children who undergo liver transplantation for end-stage liver disease, metabolic liver conditions and a variety of other indications. Pediatricians and primary care providers play vital roles in the care and management of this patient population. The purpose of this review is to highlight key aspects important to the care of the pediatric liver transplant recipient. RECENT FINDINGS Significant advances in immunosuppressive therapies and surgical techniques have contributed to improved graft and patient survival rates, shifting the focus beyond immediate survival to strategies to minimize comorbidities related to long-term immunosuppression during growing years, attend to patient and parent-reported outcomes and enhance quality of life. A multidisciplinary approach allows for monitoring and surveillance of both routine (growth, nutritional rehabilitation, cognitive development, mental and psychosocial health, contraception and daily activities) and transplant-related (adverse effects of immunosuppression, susceptible infections, extra-hepatic systems, transition from childhood to adolescence to adulthood) themes. SUMMARY Effective communication between the primary care physician and the transplant team is imperative for optimizing best outcomes. The primary care provider should be aware of the multifacet nature of posttransplant management, which includes medication regimens, common complications and infections.
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13
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Szpotanska-Sikorska M, Mazanowska N, Kociszewska-Najman B, Wielgos M, Pietrzak B. Unintended pregnancies and family planning among women after kidney or liver transplantation. J Matern Fetal Neonatal Med 2018; 33:1346-1352. [PMID: 30251568 DOI: 10.1080/14767058.2018.1518420] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Background: To evaluate the incidence of unplanned pregnancies in female organ transplant recipients.Methods: In a single-center cross-sectional study 252 women aged 18-45 years who underwent kidney or liver transplantation were asked to fill in a survey form.Results: 217 (86%) women were enrolled in the study. Fifty-three percent of women declared 181 pregnancies, of which 30% (54/181) were unplanned. Women more frequently consulted their conception with a doctor post-transplantation (74 versus 88%, p = .064). The number of unplanned pregnancies decreased post-transplantation (34 versus 20%, p = .051). The mean time elapsed from an organ transplant to unintended conception was 27.0 ± 12.5 (3.0-63.0) months. Women with longer (>24 months) rather than shorter (≤24 months) time elapsed from the transplant became pregnant less frequently (38 versus 15%, p = .060). In 70% (38/54) of unplanned pregnancies women did not use any birth control. All cases of conceptions within the post-transplant year were unintentional. Every third woman, who underwent the transplantation up to 1 year before the study enrolment, was unaware of the necessity to prevent the pregnancy.Conclusions: Although unwanted pregnancies occur more frequently in the early post-transplant period, it seems that women after kidney or liver transplantation seem to plan their pregnancies more carefully.
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Affiliation(s)
| | - Natalia Mazanowska
- 1st Department of Obstetrics and Gynaecology, Medical University of Warsaw, Warsaw, Poland
| | | | - Miroslaw Wielgos
- 1st Department of Obstetrics and Gynaecology, Medical University of Warsaw, Warsaw, Poland
| | - Bronislawa Pietrzak
- 1st Department of Obstetrics and Gynaecology, Medical University of Warsaw, Warsaw, Poland
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14
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Sarkar M, Bramham K, Moritz MJ, Coscia L. Reproductive health in women following abdominal organ transplant. Am J Transplant 2018; 18:1068-1076. [PMID: 29446243 PMCID: PMC5935794 DOI: 10.1111/ajt.14697] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Revised: 01/14/2018] [Accepted: 01/31/2018] [Indexed: 01/25/2023]
Abstract
Fertility is commonly impaired in women with end-stage kidney and liver disease, although most women will have restoration of fertility within 1 year of transplant. Family planning is therefore critical to discuss with reproductive-aged transplant recipients in the early posttransplant period, in order to ensure timely initiation of contraception, and optimal timing for conception. For women seeking pregnancy, the risks to the mother, graft, and baby should be discussed, including evaluation of immunosuppression safety and potential for adjusting medications prior to conception. With an increasing number of transplant patients now breastfeeding, immunosuppression safety in lactation continues to carry great importance.
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Affiliation(s)
- Monika Sarkar
- Department of Medicine, Division of Gastroenterology and Hepatology, University of California, San Francisco, San Francisco, CA, USA
| | - Kate Bramham
- Department of Renal Medicine, Division of Transplantation and Mucosal Biology, King’s College London, London, UK
| | - Michael J. Moritz
- Gift of Life Institute, Transplant Pregnancy Registry (TPR) International, Philadelphia, PA, USA,Lehigh Valley Health Network, Allentown, PA, USA,University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Lisa Coscia
- Gift of Life Institute, Transplant Pregnancy Registry (TPR) International, Philadelphia, PA, USA
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15
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Ghadimi M, Dashti-Khavidaki S, Shahali M, Gohari M, Khatami MR, Alamdari A. Tacrolimus interaction with oral oestrogen in kidney transplant recipients: A case-control study. J Clin Pharm Ther 2018; 43:513-518. [DOI: 10.1111/jcpt.12672] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 01/18/2018] [Indexed: 12/16/2022]
Affiliation(s)
- M. Ghadimi
- Faculty of Pharmacy, Resident of Clinical Pharmacy; Tehran University of Medical Sciences; Tehran Iran
- Resident of Clinical Pharmacy; Liver Transplantation Research Center; Imam Khomeini Hospital Complex; Tehran University of Medical Sciences; Tehran Iran
| | - S. Dashti-Khavidaki
- Nephrology Research Center; Tehran University of Medical Sciences; Tehran Iran
- Faculty of Pharmacy; Tehran University of Medical Sciences; Tehran Iran
| | - M. Shahali
- Faculty of Pharmacy; Tehran University of Medical Sciences; Tehran Iran
| | - M. Gohari
- Faculty of Pharmacy; Tehran University of Medical Sciences; Tehran Iran
| | - M.-R. Khatami
- Nephrology Research Center; Tehran University of Medical Sciences; Tehran Iran
| | - A. Alamdari
- Nephrology Research Center; Tehran University of Medical Sciences; Tehran Iran
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16
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17
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Sridhar A, Cwiak CA, Kaunitz AM, Allen RH. Contraceptive Considerations for Women with Gastrointestinal Disorders. Dig Dis Sci 2017; 62:54-63. [PMID: 27885460 DOI: 10.1007/s10620-016-4383-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Accepted: 11/15/2016] [Indexed: 12/19/2022]
Abstract
Gastroenterologists are in a unique position to assist women with chronic gastrointestinal disorders in order to optimize their health prior to pregnancy. Women, whether with chronic conditions or not, and their infants are more likely to be healthy when pregnancies are planned. Achieving a planned pregnancy at the ideal time or preventing pregnancy altogether requires the use of appropriate contraceptives. There is a broad range of contraceptives available to women in the USA, and the majority of women with digestive diseases will be candidates for all effective methods. Guidance from the Centers for Disease Control and Prevention aids clinicians in prescribing appropriate contraceptives to women with medical disorders. This review will focus on contraception for women with inflammatory bowel disease and chronic liver disease, including liver transplant.
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Affiliation(s)
- Aparna Sridhar
- The Department of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, 10833 Le Conte Ave CHS 22-229, Los Angeles, CA, 90095, USA
| | - Carrie A Cwiak
- The Department of Gynecology and Obstetrics, Emory University School of Medicine, 49 Jesse Hill Jr. Drive SE, Atlanta, GA, 30303, USA
| | - Andrew M Kaunitz
- Department of Obstetrics and Gynecology, University of Florida College of Medicine-Jacksonville, 653-1 W. 8th Street, Jacksonville, FL, 32209, USA
| | - Rebecca H Allen
- The Department of Obstetrics and Gynecology, Warren Alpert Medical School of Brown University, 101 Dudley Street, Providence, RI, 02905, USA.
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Jabiry-Zieniewicz Z, Dabrowski FA, Pietrzak B, Wyzgal J, Bomba-Opoń D, Zieniewicz K, Wielgos M. Pregnancy in the liver transplant recipient. Liver Transpl 2016; 22:1408-17. [PMID: 27197796 DOI: 10.1002/lt.24483] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 04/28/2016] [Accepted: 05/12/2016] [Indexed: 12/27/2022]
Abstract
During gestation, the woman's body undergoes various changes, and the line between physiology and pathology is very thin even in healthy women. Today, many of the liver transplant recipients are young women, who at one point in their lives may consider the possibility of pregnancy. Clinicians have to counsel them about the time of conception, the risk of miscarriage, the deterioration of the mother's health status, and the risk of birth defects. This review, based on our 20 years of clinical experience and up-to-date literature, provides comprehensive guidelines on pregnancy management in liver transplant recipients. Pregnancy in liver transplant recipients is possible but never physiological. Proper management and pharmacotherapy lowers the incidence of complications and birth defects. Critical factors for perinatal success include stable graft function before pregnancy, proper preparation for pregnancy, and cautious observation during its course. Liver Transplantation 22 1408-1417 2016 AASLD.
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Affiliation(s)
| | | | - Bronislawa Pietrzak
- 1st Department of Obstetrics and Gynecology, Medical University of Warsaw, Warsaw, Poland
| | - Janusz Wyzgal
- Department of Nephrological Nursing, Medical University of Warsaw, Warsaw, Poland
| | - Dorota Bomba-Opoń
- 1st Department of Obstetrics and Gynecology, Medical University of Warsaw, Warsaw, Poland
| | - Krzysztof Zieniewicz
- Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Warsaw, Poland
| | - Miroslaw Wielgos
- 1st Department of Obstetrics and Gynecology, Medical University of Warsaw, Warsaw, Poland
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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: 9] [Impact Index Per Article: 1.1] [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.
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Krajewski C, Sucato G. Reproductive health care after transplantation. Best Pract Res Clin Obstet Gynaecol 2015; 28:1222-34. [PMID: 25450188 DOI: 10.1016/j.bpobgyn.2014.09.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Revised: 09/03/2014] [Accepted: 09/04/2014] [Indexed: 01/01/2023]
Abstract
Contraception, cervical cancer screening, human papillomavirus (HPV) vaccination, sexually transmitted infection (STI) screening, and menstrual disorders are issues that need to be addressed in all reproductive-aged women, including those with a history of solid organ transplantation. There are specific considerations that may alter routine care in this population. Due to teratogenic immunosuppressive medications, highly effective contraception is important to planning or appropriately timing pregnancy. Estrogen-containing methods (pill, patch, and ring) may be contraindicated. Immunosuppression is also a consideration when screening for and treating STIs including precancerous conditions of the cervix. This chapter will provide a framework to address the specific gynecologic needs of women with a history of solid organ transplantation.
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Affiliation(s)
- Colleen Krajewski
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Magee-Womens Hospital, Pittsburgh, PA, USA
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CHEN HONGBO, ADAM ABDELNASIR, CHENG YANFEN, TANG SHU, HARTUNG JÖRG, BAO ENDONG. Localization and expression of heat shock protein 70 with rat myocardial cell damage induced by heat stress in vitro and in vivo. Mol Med Rep 2014; 11:2276-84. [DOI: 10.3892/mmr.2014.2986] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Accepted: 09/12/2014] [Indexed: 11/05/2022] Open
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Abstract
A working knowledge of contraception will assist the pediatrician in both sexual health promotion as well as treatment of common adolescent gynecologic problems. Best practices in adolescent anticipatory guidance and screening include a sexual health history, screening for pregnancy and sexually transmitted infections, counseling, and if indicated, providing access to contraceptives. Pediatricians' long-term relationships with adolescents and families allow them to help promote healthy sexual decision-making, including abstinence and contraceptive use. Additionally, medical indications for contraception, such as acne, dysmenorrhea, and heavy menstrual bleeding, are frequently uncovered during adolescent visits. This technical report provides an evidence base for the accompanying policy statement and addresses key aspects of adolescent contraceptive use, including the following: (1) sexual history taking, confidentiality, and counseling; (2) adolescent data on the use and side effects of newer contraceptive methods; (3) new data on older contraceptive methods; and (4) evidence supporting the use of contraceptives in adolescent patients with complex medical conditions.
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Hammoud GM, Almashhrawi AA, Ahmed KT, Rahman R, Ibdah JA. Liver diseases in pregnancy: Liver transplantation in pregnancy. World J Gastroenterol 2013; 19:7647-7651. [PMID: 24282354 PMCID: PMC3837263 DOI: 10.3748/wjg.v19.i43.7647] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Revised: 07/30/2013] [Accepted: 08/17/2013] [Indexed: 02/06/2023] Open
Abstract
Pregnancy in patients with advanced liver disease is uncommon as most women with decompensated cirrhosis are infertile and have high rate of anovulation. However, if gestation ensued; it is very challenging and carries high risks for both the mother and the baby such as higher rates of spontaneous abortion, prematurity, pulmonary hypertension, splenic artery aneurysm rupture, postpartum hemorrhage, and a potential for life-threatening variceal hemorrhage and hepatic decompensation. In contrary, with orthotopic liver transplantation, menstruation resumes and most women of childbearing age are able to conceive, give birth and lead a better quality of life. Women with orthotopic liver transplantation seeking pregnancy should be managed carefully by a team consultation with transplant hepatologist, maternal-fetal medicine specialist and other specialists. Pregnant liver transplant recipients need to stay on immunosuppression medication to prevent allograft rejection. Furthermore, these medications need to be monitored carefully and continued throughout pregnancy to avoid potential adverse effects to mother and baby. Thus delaying pregnancy 1 to 2 years after transplantation minimizes fetal exposure to high doses of immunosuppressants. Pregnant female liver transplant patients have a high rate of cesarean delivery likely due to the high rate of prematurity in this population. Recent reports suggest that with close monitoring and multidisciplinary team approach, most female liver transplant recipient of childbearing age will lead a successful pregnancy.
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Zhang M, Yue Z, Liu Z, Islam A, Rehana B, Tang S, Bao E, Hartung J. Hsp70 and HSF-1 expression is altered in the tissues of pigs transported for various periods of times. J Vet Sci 2013; 13:253-9. [PMID: 23000582 PMCID: PMC3467400 DOI: 10.4142/jvs.2012.13.3.253] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The aim of this study was to assess changes of Hsp70 and HSF-1 protein and mRNA expression in stress-sensitive organs of pigs during transportation for various periods of time. Twenty pigs were randomly divided into four groups (0 h, 1 h, 2 h, and 4 h of transportation). A significant increased activity of AST and CK was observed after 1 h and 2 h of transportation. Histopathological changes in the heart, liver, and stomach indicated that these organs sustained different degrees of injury. Hsp70 protein expression in the heart and liver of transported pigs did not change significantly while it increased significantly (p < 0.05) in the stomach. Hsp70 mRNA levels decreased significantly (p < 0.05) in the heart after 4 h of transportation. However, mRNA expression increased significantly in the liver after 1 (p < 0.05) and 4 h (p < 0.01) of transportation, and increased significantly in the stomach of the transported pigs after 1, 4 (p < 0.01), and 2 h (p < 0.05). HSF-1 levels were reduced at 1 and 4 h (p < 0.05) only in the hearts of transported pigs. These results indicate that Hsp70 mediates distinct stress-related functions in different tissues during transportation.
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Affiliation(s)
- Miao Zhang
- College of Veterinary Medicine, Nanjing Agricultural University, Nanjing 210095, China
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Pregnancy following liver transplantation: review of outcomes and recommendations for management. CANADIAN JOURNAL OF GASTROENTEROLOGY = JOURNAL CANADIEN DE GASTROENTEROLOGIE 2013; 26:621-6. [PMID: 22993734 DOI: 10.1155/2012/137129] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Liver transplantation is considered to be the treatment of choice for end-stage liver disease and its success has led to an increase in the number of female liver transplant recipients who are of childbearing age. Several key issues that are noted when counselling patients who are considering pregnancy following liver transplantation include the optimal timing of pregnancy, optimal contraception methods and the management of immunosuppression during pregnancy. The present review summarizes the most recent literature so that the clinician may address these issues with their patient and enable them to make informed decisions about pregnancy planning. The authors review recent studies examining maternal and fetal outcomes, and the rates of complications including risk of graft rejection. Subsequently, the authors provide recommendations for counselling prospective mothers and the management of the pregnant liver transplant recipient.
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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]
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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.
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Affiliation(s)
- C W N Spearman
- Red Cross War Memorial Children's Hospital, University of Cape Town Medical School, Cape Town, South Africa.
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Jacobson JC, Aikins Murphy P. United States medical eligibility criteria for contraceptive use 2010: a review of changes. J Midwifery Womens Health 2011; 56:598-607. [PMID: 22060220 DOI: 10.1111/j.1542-2011.2011.00093.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
In the late 1990s, the World Health Organization (WHO) created the Medical Eligibility Criteria for Contraceptive Use (MEC), which provide evidence-based recommendations for safe and effective contraception in women with medical problems. The WHO MEC incorporate the best available evidence, are periodically updated, and are designed to be modified for specific populations. The US Centers for Disease Control and Prevention published US MEC in 2010. Changes to WHO guidelines for use in the US population include the following areas: breastfeeding, intrauterine device use, valvular heart disease, ovarian cancer, uterine fibroids, and venous thromboembolism. Medical conditions not covered by WHO recommendations but added to the US MEC include contraceptive guidance for women with inflammatory bowel disease, history of bariatric surgery, rheumatoid arthritis, endometrial hyperplasia, history of peripartum cardiomyopathy, and history of solid organ transplant. This article reviews the changes and additions to WHO MEC found in the US MEC.
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Affiliation(s)
- Janet C Jacobson
- Universityof Utah, Department of Obstetrics and Gynecology, Salt Lake City, Utah, USA.
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Yue Z, Hao Q, Tang S, Bao E, Hartung J. Variation in Hsp90, HSF-1, and hsp90 mRNA expression in tissues of pigs exposed to different durations of transport. Livest Sci 2010. [DOI: 10.1016/j.livsci.2010.01.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Paulen ME, Folger SG, Curtis KM, Jamieson DJ. Contraceptive use among solid organ transplant patients: a systematic review. Contraception 2010; 82:102-12. [PMID: 20682148 DOI: 10.1016/j.contraception.2010.02.007] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2010] [Accepted: 02/04/2010] [Indexed: 11/26/2022]
Abstract
BACKGROUND Women undergoing solid organ transplantation are advised to avoid pregnancy for up to 24 months following transplant surgery. STUDY DESIGN We conducted a systematic review of the literature, from database (PubMed) inception through February 2009, to evaluate evidence on the safety and effectiveness of contraceptive use among women having undergone solid organ transplantation. RESULTS From 643 articles, eight articles from seven studies satisfied review inclusion criteria; six articles pertained to kidney transplant patients, and two reported on liver transplant patients. Two reports of one prospective cohort of 36 kidney transplant recipients taking combined oral contraceptives (COCs) or using the transdermal contraceptive patch reported no significant changes in biochemical measures after 18 months of use for either group, although 13 women modified antihypertensive medication, and two women discontinued the study because of serious medical complications. Four case reports of five kidney recipients using intrauterine devices reported inconsistent findings, including both beneficial health effects and contraceptive failures. One retrospective, noncomparative study of 15 liver transplant recipients using COCs or the transdermal contraceptive patch found no significant changes in any biochemical measures obtained, no discontinuations or severe complications and no pregnancies after a 12-month follow up. One case report of a liver transplant recipient on cyclosporine and prednisone documented the development of cholestasis associated with high-dose (50 mcg ethinyl estradiol) COC use as treatment for heavy uterine bleeding. CONCLUSIONS Very limited evidence on COC and transdermal contraceptive patch use among kidney and liver transplant recipients indicated no pregnancies and no overall changes in biochemical measures. Excluding case reports, evidence on other contraceptive methods or contraception among other types of solid organ transplants was not identified.
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Affiliation(s)
- Melissa E Paulen
- Centers for Disease Control and Prevention, Atlanta, GA 30341, USA
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Hasley PB, Arnold RM. Primary care of the transplant patient. Am J Med 2010; 123:205-12. [PMID: 20193824 DOI: 10.1016/j.amjmed.2009.06.034] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2009] [Revised: 06/12/2009] [Accepted: 06/18/2009] [Indexed: 01/06/2023]
Abstract
A total of 153,245 patients are living with a solid organ transplant in the US. In addition, patients are experiencing high 5-year survival rates after transplantation. Thus, primary care physicians will be caring for transplanted patients. The aim of this review is to update primary care physicians on chronic diseases, screening for malignancy, immunizations, and contraception in the transplant patient. Several studies on the treatment of hypertension and hyperlipidemia demonstrate that most agents used to treat the general population also can be used to treat transplant recipients. Little information exists on the medical management of diabetes in the transplant population, but experts in the area believe that the treatment of diabetes should be similar. Transplant recipients are at increased risk for all malignancies. Aggressive screening should be employed for all cancers with a proven screening benefit. Killed immunizations are safe for the transplant population, but live virus vaccines should be avoided. Women of childbearing age should be counseled about the impact of immunosuppressants on the efficacy and side effects of contraception.
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Affiliation(s)
- Peggy B Hasley
- University of Pittsburgh School of Medicine, PA 15213, USA.
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Abstract
Since the first pregnancy in a transplant recipient in 1958, pregnancy in recipients of solid organ transplants has become increasingly common. Although previously considered a hazardous event, data collected over the last 50 years demonstrate that despite an increased risk of maternal and fetal complications, pregnancy in transplant recipients can have a successful outcome. As of 2006, there were over 3000 female liver transplant recipients of childbearing age in the USA. Two hundred and two pregnancies and 205 outcomes were reported in 121 liver transplant recipients in the National Transplantation Pregnancy Registry. Children born to female liver recipients have a greater risk of prematurity and low birth weight than the general population, but no malformation patterns have been observed. Mothers are more likely to experience pregnancy-induced hypertension, pre-eclampsia and caesarian section, but overall mortality is not worse. Rates of acute rejection and graft loss are similar to nonpregnant liver recipients. The optimal timing of conception post-transplant is controversial, but current recommendations suggest waiting for at least 1 year after transplantation. Choice of contraception is also debatable, although barrier methods have traditionally been preferred. Many medications used for post-transplant immunosuppression have potential effects during pregnancy and breast-feeding. The risks and benefits of each medication should be reviewed with patients contemplating pregnancy, and regimens should be tailored accordingly.
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Affiliation(s)
- Bijal Surti
- Department of Medicine, UCLA Medical Center, Pfleger Liver Institute, University of California Los Angeles David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA
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Heneghan MA, Selzner M, Yoshida EM, Mullhaupt B. Pregnancy and sexual function in liver transplantation. J Hepatol 2008; 49:507-19. [PMID: 18715668 DOI: 10.1016/j.jhep.2008.07.011] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Michael A Heneghan
- Institute of Liver Studies, King's College Hospital NHS Foundation Trust, Denmark Hill, London, UK.
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