Fertility Outcome After Renal Transplantation: A Single-Center Experience

Yaprak, Muhittin; Doğru, Volkan; Sanhal, Cem Yaşar; Avanaz, Ali; Erman, Meliha

doi:10.1016/j.transproceed.2019.01.111

Cited by 3 publications

(5 citation statements)

References 13 publications

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“…There were 27 studies (14,17,24,26,28 –30,33,34,36,38,39,41,43,44,49 –56) reporting a combined total of 3534 medications used in 2706 study participants (1.25:1 ratio). The most commonly reported medications included those for anemia treatment ( e .…”

Section: Resultsmentioning

confidence: 99%

“…There were 27 studies (14,17,24,26,(28)(29)(30)33,34,36,38,39,41,43,44,(49)(50)(51)(52)(53)(54)(55)(56) reporting a combined total of 3534 medications used in 2706 study participants (1.25:1 ratio). The most commonly reported medications included those for anemia treatment (e.g., erythropoietin and ferrous sulfate; n51612; 46%), immunosuppressant medications (e.g., cyclosporin, tacrolimus, prednisone, mycophenolate mofetil, and mycophenolate sodium; n51282; 36%), and antihypertensive medications (e.g., propranolol, b-blockers, and calcium channel blockers; n5154; 4%).…”

Section: Medication Usementioning

confidence: 99%

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Menstrual Abnormalities and Reproductive Lifespan in Females with CKD

Rytz

Kochaksaraei

Skeith

et al. 2022

CJASN

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Background and objectivesMenstrual abnormalities and shortened reproductive lifespan are associated with shorter life expectancy and higher cardiovascular and osteoporosis risk in the general population, although the magnitude of these reproductive factor irregularities in females with CKD is unclear. This systematic review and meta-analysis aimed to summarize the current knowledge regarding menstrual abnormalities and reproductive lifespan among females with CKD.Design, setting, participants, & measurementsA comprehensive bibliographic search (MEDLINE, Embase, and Cumulative Index to Nursing and Allied Health Literature [CINAHL]) was completed from database inception to February 2022 to identify all original articles reporting on females of reproductive age with nondialysis-dependent/nonkidney transplant CKD, dialysis-dependent CKD, or kidney transplantation and menstruation patterns, age of menarche, and/or menopause. Data extraction and study quality assessment were completed in duplicate. Random effects meta-analyses were used to derive pooled proportions estimates.ResultsForty-six studies were identified, and 35 were meta-analyzed, stratified by KRT modality and reported outcome. Menstrual abnormalities were present in 19%–47% of patients on hemodialysis and 75% of patients on peritoneal dialysis. Kidney transplantation was associated with a 7%–30% decrease in menstrual abnormalities. Reproductive lifespan was 32 years (95% confidence interval, 30 to 34 years). Although significant heterogeneity was present, study quality ranged from fair to good, and no evidence of publication bias was noted.ConclusionsMenstrual abnormalities and shorter reproductive lifespan are common in females with CKD, although kidney transplantation may improve menstrual health.

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Section: Resultsmentioning

confidence: 99%

Section: Medication Usementioning

confidence: 99%

Menstrual Abnormalities and Reproductive Lifespan in Females with CKD

Rytz

Kochaksaraei

Skeith

et al. 2022

CJASN

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“…36 In a regression analysis, Tac use in combination with MMF (compared with other treatment options) appeared to be a positive predictor of pregnancy within 1 year for female SOT recipients trying to conceive in addition to regular menstrual cycle and age. 34 Based on the above findings, despite limited data, it appears that Tac treatment is associated with a higher to normal infertility rate among female transplant recipients.…”

Section: Effects On Female Fertilitymentioning

confidence: 88%

“…Infertility rates seem to be higher than those in the general population. In a retrospective cohort study by Yaprak et al, 34 which included 33 female renal allograft recipients on a different immunosuppressive regimen, 64% of the women, who had actively been trying did not become pregnant within 1 year. This rate is higher than that in the general population, where it is estimated that among women trying to conceive, 16% fail to become pregnant within 1 year.…”

Section: Effects On Female Fertilitymentioning

confidence: 99%

“…126 In addition, in a retrospective cohort study including 35 women who wished to become pregnant, predictors for pregnancy were analyzed, and regression analysis results showed that the use of Tac and MMF (compared with other immunosuppressive drug regimens) was a positive predictor of pregnancy within 1 year in women trying to conceive, along with regular menstrual cycles after transplantation and age at transplantation. 34 Nevertheless, although insufficient evidence is available on the effect of MPA treatment on fertility, there is no evidence of impaired fertility in both men and women.…”

Section: Fertilitymentioning

confidence: 99%

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Usage of Tacrolimus and Mycophenolic Acid During Conception, Pregnancy, and Lactation, and Its Implications for Therapeutic Drug Monitoring: A Systematic Critical Review

Le¹,

Francke

Andrews

et al. 2020

Therapeutic Drug Monitoring

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Background: Conception, pregnancy, and lactation following solid organ transplantation require appropriate management. The most frequently used immunosuppressive drug combination after solid organ transplantation consists of tacrolimus (Tac) plus mycophenolic acid (MPA). Here, the effects of Tac and MPA on fertility, pregnancy, and lactation are systematically reviewed, and their implications for therapeutic drug monitoring (TDM) are discussed. Methods: A systematic literature search was performed (August 19, 2019) using Ovid MEDLINE, EMBASE, the Cochrane Central Register of controlled trials, Google Scholar, and Web of Science, and 102 studies were included. Another 60 were included from the reference list of the published articles. Results: As MPA is teratogenic, women who are trying to conceive are strongly recommended to switch from MPA to azathioprine. MPA treatment in men during conception seems to have no adverse effect on pregnancy outcomes. Nevertheless, in 2015, the drug label was updated with additional risk minimization measures in a pregnancy prevention program. Data on MPA pharmacokinetics during pregnancy and lactation are limited. Tac treatment during conception, pregnancy, and lactation seems to be safe in terms of the health of the mother, (unborn) child, and allograft. However, Tac may increase the risk of hypertension, preeclampsia, preterm birth, and low birth weight. Infants will ingest very small amounts of Tac via breast milk from mothers treated with Tac. However, no adverse outcomes have been reported in children exposed to Tac during lactation. During pregnancy, changes in Tac pharmacokinetics result in increased unbound to whole-blood Tac concentration ratio. To maintain Tac concentrations within the target range, increased Tac dose and intensified TDM may be required. However, it is unclear if dose adjustments during pregnancy are necessary, considering the higher concentration of (active) unbound Tac. Conclusions: Tac treatment during conception, pregnancy and lactation seems to be relatively safe. Due to pharmacokinetic changes during pregnancy, a higher Tac dose might be indicated to maintain target concentrations. However, more evidence is needed to make recommendations on both Tac dose adjustments and alternative matrices than whole-blood for TDM of Tac during pregnancy. MPA treatment in men during conception seems to have no adverse effect on pregnancy outcomes, whereas MPA use in women during conception and pregnancy is strongly discouraged.

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Infertility in Female and Male Solid Organ Recipients – From Diagnosis to Treatment: An Up-To-Date Review of the Literature

et al. 2020

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Around 20% to 30% of patients after solid organ transplantation are of reproductive age. The estimated rate of infertility in this group is slightly higher than in the general population. Choosing the optimal moment for pregnancy in transplanted patients plays a pivotal role, regardless of the method of conception. The first part of this article presents an up-to-date review of the problem of infertility in female and male solid organ recipients, with special attention to the influence of specific immunosuppressive drugs on semen parameters. The second part discusses the current knowledge regarding infertility treatment and the results of assisted reproductive techniques in this specific group of patients. Despite restoring gonadal functions after transplantation, the patients should be informed about possible negative effects of medications on fertility, course of pregnancy, and the fetus. Interdisciplinary care should always be provided for infertile graft recipients, especially women, as it ensures safety both for the graft and for the potential gestation. The process of infertility diagnosis and tools used for that purpose are the same in transplanted patients as in the general population. The treatment with assisted reproductive techniques is acceptable and gives favorable results as long as patients are managed rationally, with special attention paid to prevention of iatrogenic complications.

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Fertility Outcome After Renal Transplantation: A Single-Center Experience

Cited by 3 publications

References 13 publications

Menstrual Abnormalities and Reproductive Lifespan in Females with CKD

Menstrual Abnormalities and Reproductive Lifespan in Females with CKD

Usage of Tacrolimus and Mycophenolic Acid During Conception, Pregnancy, and Lactation, and Its Implications for Therapeutic Drug Monitoring: A Systematic Critical Review

Infertility in Female and Male Solid Organ Recipients – From Diagnosis to Treatment: An Up-To-Date Review of the Literature

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