1
|
Rashidi-Alavijeh J, Frey A, Hörster A, Nguyen BP, Iannaccone A, Saner F, Lange CM, Willuweit K. Safe for Mother, Baby, and Graft? Pregnancy After Liver Transplant: A Single-Center Experience. Transplant Proc 2022; 54:744-748. [DOI: 10.1016/j.transproceed.2022.01.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 01/17/2022] [Indexed: 11/30/2022]
|
2
|
Aljerian K. Uterine transplant: an ethical framework analysis from a Middle Eastern perspective. Curr Med Res Opin 2021; 37:1049-1060. [PMID: 33705236 DOI: 10.1080/03007995.2021.1902296] [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] [Indexed: 10/21/2022]
Abstract
BACKGROUND Significant advances in infertility treatment have been achieved over the past several decades, but women with uterine dysfunction, anomaly, or agenesis still need support to carry a pregnancy to term. Recently, advancements in surgical, anesthetic and immunosuppressive therapy have brought the idea of successful uterine transplant closer to reality, but many challenges must be overcome before uterine transplant can become more common, including ethical challenges related to the study and the conduct of this procedure. METHODS This was an updated ethical analysis of uterine transplant from a Middle Eastern perspective, using an established ethical framework that has been adapted for the analysis of research in non-Western cultures and developing countries. RESULTS Using the ethical framework, this analysis explored research developments in uterine transplant to date, using the following categories: collaborative partnership, social value, scientific validity, a fair selection of study population, favorable risk-benefit ratio, independent review, informed consent, and respect for recruited participants. The analysis revealed a significant need for region- and religion-specific ethical guidelines for uterine transplant procedures. CONCLUSIONS The horizons of research need to expand by addressing and researching the ethical issues related to uterine transplant trials and clinical procedures. LIMITATIONS Limitations included the challenges related to applying ethical analyses to work in developing countries, and the fact that this analysis was based on the views and interpretations of a single researcher.
Collapse
Affiliation(s)
- Khaldoon Aljerian
- Forensic and Legal Medicine Unit, Department of Pathology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| |
Collapse
|
3
|
Gomes SZ, Araujo F, Bandeira CL, Oliveira LG, Hoshida MS, Zugaib M, Francisco RPV, Bevilacqua E. The Impact of Immunosuppressive Drugs on Human Placental Explants. Reprod Sci 2018; 26:1225-1234. [DOI: 10.1177/1933719118812739] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The use of immunosuppressive drugs guarantees the vitality of the graft and allows gestation in spite of intercurrences such as prematurity and intrauterine growth restriction. However, little is known about the direct effects of immunosuppressive drugs on placental cells. We investigated the effects of immunosuppressive drugs in the chorionic villous explants from human term placentas of healthy gestations. Human placental explants from term gestations (37-39 week gestational age, n = 12) were exposed to cyclosporine A (CSA, 0, 62.5, 125, 1250 ng/mL) or azathioprine (AZA, 0, 5, 10, 100 ng/mL) separately or, in combination for up to 48 hours. 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assays showed a significant decrease in the explant metabolic activity between AZA and the control group (24 hours, 100 ng/mL, 48 hours, all concentrations, P < .005). Cyclosporin A (CsA) reduced cell activity when associated with AZA (48 hours, P < .005). Fibrinoid deposits increased in AZA-treated explants alone (5 ng/mL, 48 hours; 10 ng/mL, 24-48 hours; P < .005) or when associated with CsA (10 AZA/125 CsA, P < .05), whereas in CsA treatment alone, there was an augment in syncytial knots (24-48 hours, P < .005). The sFLT1 gene (24 hours, P < .05) and protein ( P < .005) expression increased in AZA and CsA-treatments separately or in combination ( P < .05). Placental growth factor increased in AZA (24 hours, 10 ng/mL) and CsA (125 ng/mL; P < .05). In conclusion, our data indicate that AZA primarily acts on the villous metabolism, perturbing placental homeostasis. Since these drugs may alter the balance of angiogenic factors in its selection for clinical application, their impact on the behavior of placental villous should be considered.
Collapse
Affiliation(s)
- Sara Z. Gomes
- Department of Cellular and Developmental Biology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| | - Franciele Araujo
- Department of Cellular and Developmental Biology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| | - Carla L. Bandeira
- Department of Cellular and Developmental Biology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| | - Leandro G. Oliveira
- Gynecology and Obstetrics Department, Botucatu Medical School, Sao Paulo State University, São Paulo, Brazil
| | - Mara S. Hoshida
- Obstetrics and Gynecology Department, University of São Paulo Medical School, São Paulo, Brazil
| | - Marcelo Zugaib
- Obstetrics and Gynecology Department, University of São Paulo Medical School, São Paulo, Brazil
| | - Rossana P. V. Francisco
- Obstetrics and Gynecology Department, University of São Paulo Medical School, São Paulo, Brazil
| | - Estela Bevilacqua
- Department of Cellular and Developmental Biology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| |
Collapse
|
4
|
Choi HI, Hong JA, Kim MS, Lee SE, Jung SH, Won HS, Kim JJ. A Successful Pregnancy and Delivery after Heart Transplantation: The First Case Report from Korea. KOREAN JOURNAL OF TRANSPLANTATION 2018. [DOI: 10.4285/jkstn.2018.32.3.69] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Hyo-In Choi
- Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jung Ae Hong
- Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Min-Seok Kim
- Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sang Eun Lee
- Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sung-Ho Jung
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hye-Sung Won
- Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae-Joong Kim
- Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| |
Collapse
|
5
|
Qi X, Wang X, Huang X, Wang C, Gu Y, Li Y. Anesthesia management for cesarean section 10 years after heart transplantation: a case report. SPRINGERPLUS 2016; 5:993. [PMID: 27441126 PMCID: PMC4937040 DOI: 10.1186/s40064-016-2701-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/23/2016] [Accepted: 06/28/2016] [Indexed: 11/10/2022]
Abstract
Introduction Pregnancy after organ transplantation is becoming increasingly common. However, reports of the anesthesia for such patients are rare. Heart transplant recipients are always accompanied with pathophysiological changes and present anesthesiologists with challenge. Case description We reported a case of anesthesia management of gravida undergoing cesarean section 10 years after cardiac transplantation. We used two points spinal and epidural anesthesia, combined with phenylephrine throughout the surgery. The course was absolutely successful and both mother and baby got good results. Discussion and evaluation Physiology of heart transplant recipients and key points of anesthesia management were discussed. Conclusions Spinal anesthesia can be performed in heart transplant recipients, however, we have to think twice before anesthesia for this kind of patients.
Collapse
Affiliation(s)
- Xiaofei Qi
- Department of Anesthesiology, Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University, Shenzhen, 518028 Guangdong China
| | - Xiaolei Wang
- Department of Anesthesiology, Sun Yat-Sen Cardiovascular Hospital of Shenzhen, Shenzhen, 518028 Guangdong China
| | - Xiaolei Huang
- Department of Anesthesiology, Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University, Shenzhen, 518028 Guangdong China
| | - Chenhong Wang
- Department of Gynecology and Obstetrics, Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University, Shenzhen, 518028 Guangdong China
| | - Yin Gu
- Department of Anesthesiology, Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University, Shenzhen, 518028 Guangdong China
| | - Yuantao Li
- Department of Anesthesiology, Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University, Shenzhen, 518028 Guangdong China
| |
Collapse
|
6
|
Muthuvel VA, Ravindran M, Chander A, Veluswamy C. Successful pregnancy following single blastocyst transfer in a renal transplant recipient. J Hum Reprod Sci 2016; 9:53-5. [PMID: 27110079 PMCID: PMC4817289 DOI: 10.4103/0974-1208.178633] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Numerous spontaneous pregnancies have been reported in renal transplant recipients; however, only a few pregnancies after the use of assisted reproductive techniques. The authors report a case of renal transplant recipient with secondary infertility who delivered a healthy baby without any complications. The report highlights the importance of minimal stimulation protocol during ovarian stimulation, single embryo transfer, and the need for multispecialty care for these patients. To the best of the authors' knowledge, the present report is the first such case from India and also the second in the world to report a blastocyst transfer among renal transplant recipients.
Collapse
Affiliation(s)
- V Arun Muthuvel
- Department of Reproductive Medicine, Iswarya Women's Hospital and Fertility Centre, Chennai, Tamil Nadu, India
| | - Manipriya Ravindran
- Department of Reproductive Medicine, Iswarya Women's Hospital and Fertility Centre, Chennai, Tamil Nadu, India
| | - Aravind Chander
- Department of Reproductive Medicine, Iswarya Women's Hospital and Fertility Centre, Coimbatore, Tamil Nadu, India
| | - Chandralekha Veluswamy
- Department of Reproductive Medicine, Iswarya Women's Hospital and Fertility Centre, Chennai, Tamil Nadu, India
| |
Collapse
|
7
|
Norrman E, Bergh C, Wennerholm UB. Pregnancy outcome and long-term follow-up after in vitro fertilization in women with renal transplantation. Hum Reprod 2014; 30:205-13. [PMID: 25376456 DOI: 10.1093/humrep/deu293] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
STUDY QUESTION What is the child morbidity after IVF in women who have received a kidney transplant? SUMMARY ANSWER Overall, obstetric outcome and morbidity in children of women who had undergone renal transplantation and IVF treatment were favourable. WHAT IS KNOWN ALREADY There are several studies of the obstetric outcome in women with spontaneous conception after solid organ transplantation as well as studies of obstetric outcome after IVF in general. There are only a few case reports of women with kidney or pancreas-kidney transplantation and deliveries after IVF treatment. STUDY DESIGN, SIZE, DURATION A population-based retrospective register study was carried out in Sweden including all women with solid organ transplantation and deliveries after IVF; however, only women with kidney transplants were recruited. It also included information on all singleton deliveries after kidney transplantation and spontaneous conception between 1973 and 2012. PARTICIPANTS/MATERIALS, SETTING AND METHODS We cross-linked the IVF registers with the Medical Birth Register, the Patient Register and the Cause of Death Register. Study group 1 consisted of women with kidney transplantation and deliveries after IVF treatment. Study group 2 consisted of women with kidney transplantation and singleton deliveries after spontaneous conception. Group 3 (control group to singletons in study group 1) consisted of women without organ transplantation and with singleton deliveries after IVF, matched for maternal age, parity and date of birth. Group 4 (control group to study group 2) consisted of women without organ transplantation and with singleton deliveries after spontaneous conception, matched for maternal age, parity and year of birth. MAIN RESULTS AND THE ROLE OF CHANCE Seven singletons and one set of twins were born after organ transplantation and IVF. All women in this group had renal transplants. Among singletons, two (28.6%) were preterm births (PTB), one (14.3%) had very low birthweight (VLBW) (672 g) and one (14.3%) was small for gestational age (SGA). Two infants had minor birth defects. One woman developed pre-eclampsia (14.3%). Mean age at follow-up of the children was 9.7 years (SD 4.2). Two children were diagnosed with hyperactivity disorders. There were 199 singletons born after renal transplantation and spontaneous conception. The rates of pre-eclampsia (23.6%), PTB (48.5%), LBW (43.7%) and SGA (21.2%) were significantly higher in pregnancies of women with renal transplants who had conceived spontaneously than in pregnancies where there was no transplantation and conception was spontaneous. Neonatal morbidity, early neonatal and infant mortality were all significantly higher. No increase in birth defects was seen. Mean age at follow-up of the children was 14.7 years (SD 9.4). Acute bronchitis, systemic lupus erythematosus and hyperactivity disorders were more common in children delivered to women with renal transplantation than in children delivered to women with no transplanted organs. Otherwise, long-term child morbidity was comparable. LIMITATIONS, REASONS FOR CAUTION The women who had received renal transplants and who had given birth after IVF were a small group and may represent a selected group of comparatively healthy women. WIDER IMPLICATIONS OF THE FINDINGS The results are important to transplant recipients with infertility problems. Neonatal outcomes after maternal renal transplantation and spontaneous conception were in agreement with the literature. Long-term follow-up of this group of children has long been asked for and findings are included in this report. STUDY FUNDING/COMPETING INTERESTS No conflict of interest was reported. The study was supported by grants from Swedish Association of Local Authorities and Regions and by grants from the University of Gothenburg/Sahlgrenska University hospital (LUA/ALF 70940).
Collapse
Affiliation(s)
- Emma Norrman
- Department of Obstetrics and Gynaecology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden
| | - Christina Bergh
- Reproductive Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Ulla-Britt Wennerholm
- Department of Obstetrics and Gynaecology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden
| |
Collapse
|
8
|
Pregnancy after heart and lung transplantation. Best Pract Res Clin Obstet Gynaecol 2014; 28:1146-62. [PMID: 25179291 DOI: 10.1016/j.bpobgyn.2014.07.019] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Revised: 07/18/2014] [Accepted: 07/21/2014] [Indexed: 12/31/2022]
Abstract
Patients awaiting transplantation should be counseled regarding posttransplant contraception and the potential adverse outcomes associated with posttransplant conception. Pregnancy should be avoided for at least 1-2 years post transplant to minimize the risks to allograft function and fetal well-being. Transplant patients, particularly lung transplant recipients, have an increased risk of maternal and neonatal pregnancy-related complications, including prematurity and low birth weight, postpartum graft loss, and long-term morbidity and mortality compared to other solid-organ recipients. Therefore, careful monitoring by a specialized transplant team is crucial. Maintenance of immunosuppression is recommended, except for mycophenolate and mammalian target of rapamycin inhibitors (mTORi), which should be replaced before conception. Immunosuppressants must be regularly monitored and dosing adjusted to avoid graft rejection. Monitoring during labor is mandatory and epidural anesthesia recommended. Vaginal delivery should be standard and cesarean delivery only performed for obstetric reasons. Breastfeeding poses risks of neonatal exposure to immunosuppressants and is generally contraindicated.
Collapse
|
9
|
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
|
10
|
Ginwalla M, Pando MJ, Khush KK. Pregnancy-related human leukocyte antigen sensitization leading to cardiac allograft vasculopathy and graft failure in a heart transplant recipient: a case report. Transplant Proc 2013; 45:800-2. [PMID: 23498823 DOI: 10.1016/j.transproceed.2012.10.038] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2012] [Revised: 10/08/2012] [Accepted: 10/16/2012] [Indexed: 11/15/2022]
Abstract
In this report, we present a heart transplant recipient who developed cross-reactive paternal and donor-specific human leukocyte antigen (HLA) class II antibodies during pregnancy, leading to accelerated cardiac allograft vasculopathy and severe allograft dysfunction 17 years after transplantation. This resulted in acute heart failure and ventricular arrhythmias requiring repeat heart transplantation.
Collapse
Affiliation(s)
- M Ginwalla
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California 94305, USA
| | | | | |
Collapse
|
11
|
Than NN, Neuberger J. Liver abnormalities in pregnancy. Best Pract Res Clin Gastroenterol 2013; 27:565-75. [PMID: 24090943 DOI: 10.1016/j.bpg.2013.06.015] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2013] [Accepted: 06/21/2013] [Indexed: 01/31/2023]
Abstract
Abnormalities of liver function (notably rise in alkaline phosphatase and fall in serum albumin) are common in normal pregnancy, whereas rise in serum bilirubin and aminotransferase suggest either exacerbation of underlying pre-existing liver disease, liver disease related to pregnancy or liver disease unrelated to pregnancy. Pregnant women appear to have a worse outcome when infected with Hepatitis E virus. Liver diseases associated with pregnancy include abnormalities associated hyperemesis gravidarum, acute fatty liver disease, pre-eclampsia, cholestasis of pregnancy and HELLP syndrome. Prompt investigation and diagnosis is important in ensuring a successful maternal and foetal outcome. In general, prompt delivery is the treatment of choice for acute fatty liver, pre-eclampsia and HELLP syndrome and ursodeoxycholic acid is used for cholestasis of pregnancy although it is not licenced for this indication.
Collapse
Affiliation(s)
- Nwe Ni Than
- Liver Unit, Queen Elizabeth Hospital, Birmingham B15 2TH, UK
| | | |
Collapse
|
12
|
Koyama S, Tomimatsu T, Kanagawa T, Daimon E, Kimura T, Kuroda A, Tanemura M, Doki Y, Ito T. Successful pregnancy after simultaneous pancreas-kidney transplantation from a brain-dead donor: the first case report in Japan. J Obstet Gynaecol Res 2011; 37:1711-6. [PMID: 21676071 DOI: 10.1111/j.1447-0756.2011.01560.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Simultaneous pancreas-kidney transplantation is a revolutionary medical procedure to cure diabetes mellitus and its complications in one step. For women with type 1 diabetes mellitus and end-stage renal disease, this procedure not only treats their disease but may also allow them to have children. Worldwide, 77 pregnancies from 43 pancreas-kidney recipients have been reported. Here, we present the first case report of successful pregnancy after simultaneous pancreas-kidney transplantation from a brain-dead donor in Japan. She conceived spontaneously 32 months after transplantation. Her pregnancy course was favorable except for mild rejection of the grafted pancreas and development of gestational diabetes. She delivered a 2882-g healthy infant in October 2010. Pregnancy after simultaneous pancreas-kidney transplantation is discussed.
Collapse
Affiliation(s)
- Shinsuke Koyama
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan.
| | | | | | | | | | | | | | | | | |
Collapse
|
13
|
Live birth after in vitro fertilization and single embryo transfer in a kidney transplant patient: a case report and review of the literature. J Assist Reprod Genet 2010; 28:351-3. [PMID: 21161364 DOI: 10.1007/s10815-010-9521-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2010] [Accepted: 11/23/2010] [Indexed: 10/18/2022] Open
Abstract
BACKGROUND To present a successful case of in vitro fertilization (IVF) and single embryo transfer (SET) in a kidney transplant (NTX) patient and review of the literature. METHODS Case report and review of the literature. SETTING IVF-Unit in a university medical center. PATIENT(S) A 31 year-old nulliparous woman with primary infertility and a history of two kidney transplants. INTERVENTION(S) IVF-SET MAIN OUTCOME MEASURE(S): Live birth, renal transplant function. RESULTS(S) IVF-SET resulted in a pregnancy with labor induction and cesarean delivery in the 37th week of gestation due to rising serum creatinine. There was no significant maternal or fetal morbidity. CONCLUSION(S) Successful IVF-SET is possible in NTX patients. To date, including this case, five cases of IVF in NTX patients have been reported in the literature without an apparently increased renal morbidity.
Collapse
|
14
|
McNaughton S, Farley D, Staggs R, Heinz D, Gray W. Pregnancy, Fertility, and Contraception Risk in the Context of Chronic Disease. J Nurse Pract 2008. [DOI: 10.1016/j.nurpra.2008.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
15
|
Affiliation(s)
- Laurie G. Futterman
- Laurie G. Futterman is the clinical coordinator of the cardiothoracic transplant program at the University of Miami Miller School of Medicine/Jackson Memorial Medical Center. Louis Lemberg is professor of clinical cardiology in the Division of Cardiology, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida
| | - Louis Lemberg
- Laurie G. Futterman is the clinical coordinator of the cardiothoracic transplant program at the University of Miami Miller School of Medicine/Jackson Memorial Medical Center. Louis Lemberg is professor of clinical cardiology in the Division of Cardiology, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida
| |
Collapse
|
16
|
Fichez A, Labrousse C, Fromajoux C, Bordes A, Hadj S, Audra P, Salle B. Successful pregnancy outcome after in vitro fertilization in a pancreas-kidney recipient. Fertil Steril 2007; 90:849.e1-3. [PMID: 18054005 DOI: 10.1016/j.fertnstert.2007.08.038] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2007] [Revised: 08/15/2007] [Accepted: 08/15/2007] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To describe the first case of IVF pregnancy in a pancreas-kidney recipient. DESIGN Case report. SETTING Reproductive Medicine Department, Hôpital Edouard Herriot, Lyon, France. INTERVENTION(S) In vitro fertilization in a pancreas-kidney recipient. PATIENT(S) A 39 year-old nulliparous woman, with primary infertility and a history of pancreas-kidney transplant at 29 years of age. MAIN OUTCOME MEASURE(S) Multidisciplinary agreement for the couple to be managed by IVF. Follow-up of pregnancy and delivery. RESULT(S) Singleton IVF pregnancy in a pancreas-kidney recipient, maintained up to 34 weeks. Cesarian delivery ahead of labor. No severe maternal or fetal complications. Live birth. Normal postpartum renal function and glycemia. CONCLUSION(S) An IVF pregnancy is feasible in a pancreas-kidney recipient. Such treatment should follow agreement by all the medical teams following the patient. Pregnancy in a pancreas-kidney recipient is at-risk, requiring close monitoring.
Collapse
Affiliation(s)
- Axel Fichez
- Département de Médecine de Reproduction, Hôpital Edouard Herriot, Lyon, France
| | | | | | | | | | | | | |
Collapse
|
17
|
Perinatal outcome following renal transplantation. Int J Gynaecol Obstet 2007; 96:76-9. [DOI: 10.1016/j.ijgo.2006.11.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2006] [Revised: 10/28/2006] [Accepted: 11/01/2006] [Indexed: 11/22/2022]
|
18
|
Abstract
OBJECTIVE The presence of underlying pulmonary disease in women of childbearing potential can present a significant challenge during pregnancy and the postpartum period. Management of the underlying disease, recognizing and preventing disease progression, and, most important, managing and minimizing toxic side effects of various therapies require the expertise of an interdisciplinary team. This team must involve close collaboration between intensive care physicians, pulmonary physicians, and high-risk obstetricians familiar with these disease states in an effort to minimize fetal and maternal morbidity and mortality. We will review the impact of the pregnant state in lung transplant recipients, patients with pulmonary arterial hypertension, and patients with underlying cystic fibrosis. DESIGN Review of the literature in regards to pregnancy outcomes and issues for patients with cystic fibrosis, pulmonary hypertension, and lung transplants. METHODS A review of the epidemiology, pathophysiology, risk factors, classification, clinical features, and outcomes for pregnant patients with underlying pulmonary diseases. CONCLUSIONS Safety of pregnancy in the female lung transplant recipient concerns three outcomes: maternal outcome, fetal outcome, and transplanted graft outcome.
Collapse
Affiliation(s)
- Marie M Budev
- Lung Transplantation Program, Department of Allergy, Pulmonary, and Critical Care Medicine, The Cleveland Clinic Foundation, Cleveland, OH, USA
| | | | | |
Collapse
|
19
|
Abstract
The frequency and variety of solid organ transplantation in reproductive-age women increases each year. Pregnancy is no longer contraindicated in transplant recipients provided that their graft is functioning well and they are in good general health. Physicians who care for pregnant transplant recipients should be aware of the surmounting data that are available in the literature and through registries of maternal, fetal, and neonatal risks and complications as well as outcome data. Newer immunosuppressive agents preserve graft function and registry data attest to their safety in pregnancy. For optimal maternal and neonatal outcomes, a multispecialty care approach that includes the obstetrician/maternal-fetal specialist,transplant team, anesthesiologist, and neonatal team is prudent when caring for pregnancies after organ transplantation.
Collapse
Affiliation(s)
- Joan M Mastrobattista
- Department of Obstetrics, Gynecology, & Reproductive Sciences, University of Texas Health Science Center at Houston, 6431 Fannin, Suite 3.604, Houston, TX 77030, USA.
| | | |
Collapse
|
20
|
Bar J, Stahl B, Hod M, Wittenberg C, Pardo J, Merlob P. Is immunosuppression therapy in renal allograft recipients teratogenic? A single-center experience. Am J Med Genet A 2003; 116A:31-6. [PMID: 12476448 DOI: 10.1002/ajmg.a.10817] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The aim of the study was to determine whether immunosuppressive agents used in renal allograft recipients are teratogenic or otherwise associated with pregnancy outcome. The study population consisted of 38 renal allograft recipients treated with combinations of prednisone, azathioprine, cyclosporin A, and tacrolimus attending our Hypertension in Pregnancy Clinic. The 48 live offspring of 73 pregnancies in this group were evaluated for major congenital malformations and mild errors of morphogenesis. Findings were compared with those in 48 offspring of 41 women with primary renal disease not treated with immunosuppressive drugs. Pregnancy outcome parameters were also compared between the study and control groups in the perinatal period and on a long-term basis (2-7 years after birth). Two major anomalies (4.2%), subcoronal hypospadias and rudimentary thumb, and 10 mild errors of morphogenesis (20.8%) were detected in the study group. These rates did not differ significantly from those in the control group (4.2% and 16.6%, respectively). Pregnancy outcome was worse in the renal transplant patients than in the women with primary renal disease in terms of prematurity (60% vs. 21%, P = 0.001), growth restriction (52% vs. 17%, P = 0.001), and hospitalization in a neonatal intensive care unit (35% vs. 6%, P = 0.01). In conclusion, the similar prevalence of major anomalies and mild errors of morphogenesis in offspring of the renal transplant patients and the women with primary renal disease suggests that immunosuppressive therapy is not a teratogenic factor. It may, however, be associated with worse pregnancy outcome.
Collapse
Affiliation(s)
- Jacob Bar
- Perinatal Division, Department of Obstetrics and Gynecology, Rabin Medical Center, Beilinson Campus, Petah Tiqva, Israel
| | | | | | | | | | | |
Collapse
|
21
|
Tan PK, Tan A, Koon TH, Vathsala A. Effect of pregnancy on renal graft function and maternal survival in renal transplant recipients. Transplant Proc 2002; 34:1161-3. [PMID: 12072304 DOI: 10.1016/s0041-1345(02)02772-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- P K Tan
- Department Obstetrics and Gynaecology, Singapore General Hospital, Singapore, Singapore.
| | | | | | | |
Collapse
|