Pregnancy following renal transplantation

Sciarra, John J.; Toledo‐Pereyra, Luis H.; Bendel, Richard P.; Simmons, Richard L.

doi:10.1016/s0002-9378(16)33442-1

Cited by 48 publications

(12 citation statements)

References 25 publications

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“…The frequency of multiple pregnancies appears to be increased in women with renal transplants. Sciarra et al (1975) had one set of twins (6%) in their series of 17 pregnancies; four sets of twins (3 %) and one set of triplets (1 %) were noted among the 120 successful pregnancies reported by the European Dialysis and Transplant Association (1980); and two sets of twins (5 %) were included among the 38 pregnancies reported by O'Donnell et al (1985). In our series multiple pregnancy occurred in four of 133 cases (3%).…”

Section: Discussionmentioning

confidence: 50%

Pregnancy after renal transplantation: 25 years experience in Spain

Cararach¹,

Carmona²,

Monleón³

et al. 1993

BJOG

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Objective To study the outcome of pregnancy in renal transplant patients in Spain. Design A retrospective review based on two consecutive national inquiries. Setting Departments of Obstetrics and Gynaecology and Renal Transplant Units in Spain. Subjects Pregnant women who had renal transplants between 1965 and 1989. Main outcome measures From the preliminary inquiry the frequencies of miscarriage, therapeutic abortion, preterm birth, fetal malformation, twins, stillbirths, neonatal deaths and loss of maternal renal function were recorded. The subsequent, more detailed inquiry provided additional information including donor type, previous rejection episodes and interval between rejection and pregnancy, previous creatinine level, previous hypertension and development of hypertension in pregnancy, developments during labour and delivery and the occurrence of intra uterine growth retardation and low birth weight. Results The preliminary inquiry yielded information about 133 pregnancies. The miscarriage rate was 10% and the therapeutic abortion rate was 16%. Of the 99 pregnancies that continued, 46% ended before term and 53% progressed to term. The perinatal mortality rate was 107.8 per 1000 and 4% of the infants had minor congenital malformations. The second inquiry yielded more detailed data about 66 pregnancies. There were no therapeutic abortions and 12% of the pregnancies ended in miscarriage. Among the 58 pregnancies that reached 28 weeks gestation, preterm birth occurred in 28 (48%) and intra uterine growth retardation occurred in 17 (29%). Among 48 women with normal renal function before pregnancy, the perinatal mortality rate was 68 per 1000, the miscarriage rate was 8% and in 10 of these women (21%) renal function was impaired after pregnancy. In constrast, among 18 women with impaired renal function before pregnancy, the perinatal mortality rate was 142 per 1000, the miscarriage rate was 22% and in six of these women (33%) renal function deteriorated after the pregnancy. Impairment of renal function was most common in women with hypertension during pregnancy or with rejection episodes during the year before conception. Conclusions Women with a renal transplant can have a successfull pregnancy, but there are definite risks for both mother and fetus. Pregnancy should be discussed with the woman and encouraged only if there is good renal graft function.

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Section: Discussionmentioning

confidence: 50%

Pregnancy after renal transplantation: 25 years experience in Spain

Cararach¹,

Carmona²,

Monleón³

et al. 1993

BJOG

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“…7,9,12 This high risk for preeclampsia has been described in renal transplant recipients as well and is therefore not an organ-specific phenomenon. 27,28,30 Management of preeclampsia in this population has been identical to that in the nontransplant population. The safety of commonly used therapeutic agents, such as magnesium, phenobarbital, calcium channel blockers, alphamethyldopa, hydralazine, and beta-blockers, has been assumed but not subjected to prospective trials.…”

Section: Discussionmentioning

confidence: 89%

Pregnancy after liver transplantation

et al. 2000

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The first known posttransplantation pregnancy was in 1958 in a renal transplant recipient who had received a kidney from her identical twin sister. The first known posttransplantation pregnancy in a liver transplant recipient was in 1978. Information available from female kidney transplant recipients helped in the decision making involved in the management of this case, as well as those that followed. Over the last 20 years, issues specific to liver transplantation and pregnancy have been identified. Similar to the kidney transplant recipient population, when prepregnancy recipient graft function is stable and adequate, pregnancy appears to be well tolerated. Also similar to kidney transplant recipients, there has been no evidence of a specific malformation pattern among the children, and although prematurity and low birth weight occur, overall newborn outcomes have been favorable. Pregnancy in the setting of recurrent liver disease, such as recurrent hepatitis C, poses a potential problem among liver transplant recipients, as well as the possible adverse effects of immunosuppression on maternal kidney function. Also of significance, peripartum graft deterioration has more severe consequences in this transplant recipient population. Therefore, pregnancy must be considered carefully in this transplant recipient group. Since 1991, the National Transplantation Pregnancy Registry (NTPR) has studied the safety of pregnancy outcomes in solid-organ transplant recipients. The purpose of this review is to catalog studies in the literature, as well as to present current data from the registry with management guidelines. (Liver Transpl 2000;6:671-685.)

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“…It is also possible to imagine that in cases where transplantation had been awaited for a long time and had been experienced as a 'miracle' more than as a therapeutic procedure, the patient's expectations were fulfilled to the extent that she would not want to run any additional risk to her graft. This is all the more so as pregnancy has often been accused of adversely affecting graft function in a sizeable proportion of mothers [5,13,25].…”

Section: Discussionmentioning

confidence: 99%

“…The reports on pregnancies in women after renal transplantation are quite numerous [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] but mainly describe the experience obtained in single centres and therefore relate to a relatively small number of cases. The main problems that have to be considered in transplanted women who wish to become pregnant are the potential risks to the fetus (survival, malformations) and the potential risks to the mother (survival, graft function).…”

Section: Introductionmentioning

confidence: 99%

Successful pregnancies in women on renal replacement therapy: Report from the EDTA Registry

Rizzoni

Ehrich

Broyer³

et al. 1992

Nephrology Dialysis Transplantation

122

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Abstract. This study reports the geographical incidence of successful pregnancies in women on renal replacement therapy (RRT) and related information on gestation and clinical status of newborns. The impact of successful pregnancy on graft function was assessed by means of a retrospective case-control study.Since 1977 special questionnaires have been sent to each dialysis and transplant centre which reported babies born to mothers on RRT on the yearly centre questionnaire. After 10 years of data collection, a total of 490 pregnancies and 500 babies were available for analysis. A percentage of 88.4 of the babies were born to mothers with a functioning graft, 11.2% to mothers on chronic haemodialysis, and the remaining 0.4% to mothers on CAPD.Almost 50% of all successful pregnancies wereCorrespondence and ojfprint requem to: Professor F. P. Brunner, EDTA Registry, St Thomas' Hospital, London SE1 7EH, UK.reported from the UK. The number of successful pregnancies increased steadily and in parallel with the increasing number of females of childbearing age with a functioning renal transplant. The majority of mothers delivered at age 24-32. For transplanted mothers delivery occurred most commonly during the 3rd and 4th year after successful transplantation. In approximately 85% of cases the duration of pregnancy was shorter than the lower 10th percentile of normal. Birthweight was reduced in accordance with gestational age. Newborn mortality was 1.8%.Fifty-three mothers with a successful pregnancy in 1984 1987 were computer matched with controls according to a number of criteria. The serum creatinine concentration recorded in coded form at the end of each year on the individual EDTA patient questionnaire was used to assess changes in graft function. In 94% of these cases the serum creatinine, recorded 0 11 months before delivery, did not exceed 160 umol/1. Graft function deteriorated in 18% of 280 G. Rizzoni el ai mothers as compared to 24% of controls. Twentyfour to 36 months postpartum, changes of serum creatinine were similar in test cases and controls, suggesting that a successful pregnancy does not adversely affect graft function if this was stable and well preserved at the time of conception.

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Pregnancy following renal transplantation

Cited by 48 publications

References 25 publications

Pregnancy after renal transplantation: 25 years experience in Spain

Pregnancy after renal transplantation: 25 years experience in Spain

Pregnancy after liver transplantation

Successful pregnancies in women on renal replacement therapy: Report from the EDTA Registry

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