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Hortu I, Arı SA, Akdemir A, Koroglu OA, Yılmaz M, Toz H, Sagol S, Ergenoglu AM. Perinatal outcomes of renal transplant pregnancies: a 22-year experience at a single tertiary referral center. J Matern Fetal Neonatal Med 2019; 33:3028-3034. [PMID: 31288677 DOI: 10.1080/14767058.2019.1639664] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Background: Renal transplantation not only prolongs survival but also improves quality of life and fertility, particularly in patients with end-stage renal disease. The aim of this study was to evaluate the renal and perinatal outcomes of pregnancy after renal transplantation at a high volume academic tertiary hospital.Methods: Fifty-one renal transplant patients (RTPs) who experienced pregnancy after transplantation and received care at Ege University Hospital between January 1995 and December 2017 were retrospectively identified. Data on demographics, comorbidities, and clinical perinatal outcomes were analyzed.Results: The median age of expectant mothers with renal transplantation was 30.51 ± 5.28 years (range 23-41). The mean interval between discontinuing birth control methods and the last menstrual period was 22 months. Preeclampsia occurred in six pregnancies (11.5%), and 43 of 52 pregnancies resulted in live births (82.6%). The mean gestational age at birth was 36.35 ± 2.36 weeks (range: 26-38). A total of 15 births were preterm deliveries (28.8%). Intrauterine growth retardation (IUGR) was detected in four cases. The mean birth weight was 2664.58 ± 613.99 g (range: 600-3.800 g). Twelve newborns were hospitalized in the neonatal intensive care unit (23%). A significant inverse correlation between birth weight and preconception serum creatinine level was found (p < .001; r = -0.532). An inverse correlation between the interval between transplantation and pregnancy and low postpartum serum creatinine level was established significantly (p < .05; r = -0.331). In addition, an inverse correlation between preconceptional serum creatinine and postpartum serum creatinine in the first year was found statistically significant (p < .001, r = -0.681).Conclusion: Even though pregnancy does not seem to adversely affect renal graft function, risks of perinatal as well as obstetrical complications should not be ignored. Pregnancies in RTPs should be followed closely by a multidisciplinary team of experts to minimize perinatal complications before and during pregnancy.
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Affiliation(s)
- Ismet Hortu
- Department of Obstetrics and Gynecology, Ege University School of Medicine, Izmir, Turkey
| | - Sabahattin Anıl Arı
- Department of Obstetrics and Gynecology, Ege University School of Medicine, Izmir, Turkey
| | - Ali Akdemir
- Department of Obstetrics and Gynecology, Ege University School of Medicine, Izmir, Turkey
| | - Ozge Altun Koroglu
- Department of Pediatrics, Division of Neonatology, Ege University School of Medicine, Izmir, Turkey
| | - Mumtaz Yılmaz
- Department of Internal Medicine, Division of Nephrology, Ege University School of Medicine, Izmir, Turkey
| | - Huseyin Toz
- Department of Internal Medicine, Division of Nephrology, Ege University School of Medicine, Izmir, Turkey
| | - Sermet Sagol
- Department of Obstetrics and Gynecology, Ege University School of Medicine, Izmir, Turkey
| | - A Mete Ergenoglu
- Department of Obstetrics and Gynecology, Ege University School of Medicine, Izmir, Turkey
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Pregnancy and Renal Transplantation. Nephrourol Mon 2018. [DOI: 10.5812/numonthly.63052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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3
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Yuksel Y, Tekin S, Yuksel D, Duman I, Sarier M, Yucetin L, Turan E, Celep H, Ugurlu T, Inal MM, Asuman YH, Demirbas A. Pregnancy and Delivery in the Sequel of Kidney Transplantation: Single-Center Study of 8 Years' Experience. Transplant Proc 2017; 49:546-550. [PMID: 28340831 DOI: 10.1016/j.transproceed.2017.02.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Depending on hyphothalamic, hyphophyseal, and gonadal axis dysfunction, anovulatory irregular cycles occur and the probability of pregnancy decreases in the patients with chronic kidney disease (CKD). Maternal mortality and morbidity rates are increased in CKD patients; the risk of premature delivery is 70% and the risk of preeclampsia is 40% more than normal among those with a creatine level of >2.5 mg/dL. METHODS If a pregnancy is expected in the sequel of kidney transplantation (KT), a multidisciplinary team approach should be adopted and both the gynecologist and the nephrologist should follow the patient simultaneously. Among 3883 patients who underwent KT at Antalya Medical Park Hospital Transplantion Department between November 2009 and October 2016, the records of 550 female patients between the ages of 18 and 40 years were examined retrospectively; 31 patients who complied with these criteria were included in the study group. In 6 of these patients who had an unplanned pregnancy, medical abortion was performed after the families were informed about the possible fetal anomalies caused by the use of everolimus in the first trimester, and they were excluded from the study (pregnant group). The control group consisted of 43 patients who had a KT and became pregnant, and of those who had recently undergone KT and shared similarities regarding age, CKD etiology, duration of dialysis, and number of transplants. RESULTS In both groups, the ages of the patients, their follow-up span and dialysis duration, tissue compatibility, age of the donor, and time elapsed until the pregnancy was analyzed, whereas in the control group, creatinine levels in the first, second, third, and fourth years after the KT were reviewed. Additionally, in the pregnant group, creatinine levels of the first, second, and third trimesters; delivery week; birth weight of the baby; APGAR scores of the first minute; postnatal creatinine levels of first, second, and third years; and prenatal, maternal, and postnatal acute rejections were reviewed. We measured the creatine clearance by use of the Cockcroft-Gault formula in the pregnancy group before pregnancy and during delivery [Cockcroft-Gault formula: (140 - age) × body weight (kg)/72 × plasma creatine level (mg/dL) × 0.85]. CONCLUSIONS Pregnancy after KT is risky both for the mother and the baby; however, if planned and followed in coordination within an experienced center, both the pregnancy period and the birth process can occur without distress.
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Affiliation(s)
- Y Yuksel
- Department of General Surgery and Transplantation, Medical Park Hospital, Antalya, Turkey.
| | - S Tekin
- Department of General Surgery, Faculty of Medicine, Kemerburgaz University, Istanbul, Turkey
| | - D Yuksel
- Department of Anesthesia, and Reanimasyon Unit, Training and Research Hospital, Antalya, Turkey
| | - I Duman
- Department of Urology, Faculty of Medicine, Kemerburgaz University, Istanbul, Turkey
| | - M Sarier
- Department of Urology, Faculty of Medicine, Kemerburgaz University, Istanbul, Turkey
| | - L Yucetin
- Department of General Surgery and Transplantation, Medical Park Hospital, Antalya, Turkey
| | - E Turan
- Department of General Surgery and Transplantation, Medical Park Hospital, Antalya, Turkey
| | - H Celep
- Department of General Surgery and Transplantation, Medical Park Hospital, Antalya, Turkey
| | - T Ugurlu
- Department of Obstetrics and Gynecology, Medical Park Hospital, Antalya, Turkey
| | - M M Inal
- Department of Obstetrics and Gynecology, Faculty of Medicine, Kemerburgaz University, Istanbul, Turkey
| | - Y H Asuman
- Department of Nephrology and Transplantation, Medical Park Hospital, Antalya, Turkey
| | - A Demirbas
- Department of General Surgery and Transplantation, Medical Park Hospital, Antalya, Turkey
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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.
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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
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Rupley DM, Janda AM, Kapeles SR, Wilson TM, Berman D, Mathur AK. Preconception counseling, fertility, and pregnancy complications after abdominal organ transplantation: a survey and cohort study of 532 recipients. Clin Transplant 2014; 28:937-45. [PMID: 24939245 DOI: 10.1111/ctr.12393] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND Pregnancy after solid organ transplant is a significant priority for transplant recipients but how patients report being counseled is unknown. METHODS We performed a single-center retrospective cohort study and telephone survey of female patients ages 18-49 at the time of kidney, pancreas, or liver transplant from 2000 to 2012 (n = 532). Data on pregnancy counseling, fertility, and maternal, fetal- and transplant-specific outcomes were collected. Multivariate Cox models assessed the impact of pregnancy on graft-specific outcomes. RESULTS The survey response rate was 29% (n = 152). One-third (n = 51) of women were actively counseled against pregnancy by one or more providers. A total of 17 pregnancies occurred among nine patients (5.9%), with 47% live births, 47% early embryonic demises, 5.9% stillbirths. Of live births, 50% were premature. Gestational complications, including diabetes, hypertension, and preeclampsia were present in 88% of mothers. Pregnancy after transplant was associated with higher rates of acute rejection than nulliparous transplant recipients (33% vs. 5.6%, p = 0.07) but did not significantly affect graft survival (HR = 1.00, 95% CI 0.99-1.01), after stratifying by organ and adjusting for clinical factors. CONCLUSION This study suggests that transplant patients are being counseled against pregnancy despite acceptable risks of complications and no specific effects on long-term graft function.
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Affiliation(s)
- Devon M Rupley
- Section of Transplantation Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI, USA
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do Prado KM, Correa-Silva S, Oliveira LG, Camara NOS, Ono É, Sandri S, Tourino MC, Campa A, de Sá Lima L, Scavone C, Bevilacqua E. Indoleamine 2,3-dioxygenase (IDO) Activity in Placental Compartments of Renal-Transplanted Pregnant Women. Am J Reprod Immunol 2014; 72:45-56. [DOI: 10.1111/aji.12233] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Accepted: 02/20/2014] [Indexed: 11/26/2022] Open
Affiliation(s)
- Karen Matias do Prado
- Department of Cell and Developmental Biology; Institute of Biomedical Sciences; University of São Paulo; São Paulo SP Brazil
| | - Simone Correa-Silva
- Department of Cell and Developmental Biology; Institute of Biomedical Sciences; University of São Paulo; São Paulo SP Brazil
- Post-graduate Program in Gynecology Obstetrics and Mastology; Botucatu Medical School; UNESP - São Paulo State University; Botucatu Brazil
| | - Leandro Gustavo Oliveira
- Department of Immunology; Institute of Biomedical Sciences; University of São Paulo; São Paulo SP Brazil
| | - Niels Olsen Saraiva Camara
- Department of Immunology; Institute of Biomedical Sciences; University of São Paulo; São Paulo SP Brazil
| | - Érica Ono
- Department of Pediatrics; School of Medicine; Federal University of São Paulo; São Paulo SP Brazil
| | - Silvana Sandri
- Department of Clinical and Toxicological Analysis; Faculty of Pharmaceutical Sciences; University of São Paulo; São Paulo SP Brazil
| | - Melissa Cavalheiro Tourino
- Department of Clinical and Toxicological Analysis; Faculty of Pharmaceutical Sciences; University of São Paulo; São Paulo SP Brazil
| | - Ana Campa
- Department of Clinical and Toxicological Analysis; Faculty of Pharmaceutical Sciences; University of São Paulo; São Paulo SP Brazil
| | - Larissa de Sá Lima
- Department of Pharmacology; Institute of Biomedical Sciences; University of São Paulo; São Paulo SP Brazil
| | - Cristoforo Scavone
- Department of Pharmacology; Institute of Biomedical Sciences; University of São Paulo; São Paulo SP Brazil
| | - Estela Bevilacqua
- Department of Cell and Developmental Biology; Institute of Biomedical Sciences; University of São Paulo; São Paulo SP Brazil
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Richman K, Gohh R. Pregnancy after renal transplantation: a review of registry and single-center practices and outcomes. Nephrol Dial Transplant 2012; 27:3428-34. [PMID: 22815546 DOI: 10.1093/ndt/gfs276] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Registries from North America, Australia and Europe are rich sources of clinical data on pregnancy after kidney transplantation. Single-center reports of pregnancy outcomes are limited by small sample sizes but not by the potential reporting bias that can impact registry data. Despite the differences in data pools, the obstetric and graft outcomes reported by single centers and registries have been similar. The majority of pregnancies are successful in renal transplant patients, but the risk of complications like pre-eclampsia, low birth weight and premature birth is high. Pregnancy has no significant impact on graft function or survival when baseline function is normal.
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Perales-Puchalt A, Vila Vives JM, López Montes J, Diago Almela VJ, Perales A. Pregnancy outcomes after kidney transplantation-immunosuppressive therapy comparison. J Matern Fetal Neonatal Med 2011; 25:1363-6. [DOI: 10.3109/14767058.2011.634461] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Deshpande NA, James NT, Kucirka LM, Boyarsky BJ, Garonzik-Wang JM, Montgomery RA, Segev DL. Pregnancy outcomes in kidney transplant recipients: a systematic review and meta-analysis. Am J Transplant 2011; 11:2388-404. [PMID: 21794084 DOI: 10.1111/j.1600-6143.2011.03656.x] [Citation(s) in RCA: 224] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Approximately 50,000 women of reproductive age in the United States are currently living after kidney transplantation (KT), and another 2800 undergo KT each year. Although KT improves reproductive function in women with ESRD, studies of post-KT pregnancies are limited to a few voluntary registry analyses and numerous single-center reports. To obtain more generalizable inferences, we performed a systematic review and meta-analysis of articles published between 2000 and 2010 that reported pregnancy-related outcomes among KT recipients. Of 1343 unique studies, 50 met inclusion criteria, representing 4706 pregnancies in 3570 KT recipients. The overall post-KT live birth rate of 73.5% (95%CI 72.1-74.9) was higher than the general US population (66.7%); similarly, the overall post-KT miscarriage rate of 14.0% (95%CI 12.9-15.1) was lower (17.1%). However, complications of preeclampsia (27.0%, 95%CI 25.2-28.9), gestational diabetes (8.0%, 95%CI 6.7-9.4), Cesarean section (56.9%, 95%CI 54.9-58.9) and preterm delivery (45.6%, 95%CI 43.7-47.5) were higher than the general US population (3.8%, 3.9%, 31.9% and 12.5%, respectively). Pregnancy outcomes were more favorable in studies with lower mean maternal ages; obstetrical complications were higher in studies with shorter mean interval between KT and pregnancy. Although post-KT pregnancy is feasible, complications are relatively high and should be considered in patient counseling and clinical decision making.
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Affiliation(s)
- N A Deshpande
- Department of Surgery Department of Epidemiology, Johns Hopkins School of Medicine, Baltimore, MD, USA
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Çelik G, Töz H, Ertilav M, Aşgar N, Özkahya M, Başci A, Hoşcoşkun C. Biochemical Parameters, Renal Function, and Outcome of Pregnancy in Kidney Transplant Recipient. Transplant Proc 2011; 43:2579-83. [DOI: 10.1016/j.transproceed.2011.06.041] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2011] [Revised: 05/06/2011] [Accepted: 06/13/2011] [Indexed: 11/29/2022]
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Di Loreto P, Martino F, Chiaramonte S, Dissegna D, Ronco C, Marchesoni D, Catapano P, Romano G, Montanaro D. Pregnancy After Kidney Transplantation: Two Transplantation Centers—Vicenza–Udine Experience. Transplant Proc 2010; 42:1158-61. [DOI: 10.1016/j.transproceed.2010.03.082] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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