Successful Pregnancy in Renal Transplant Recipients Treated With Cyclosporine

Al-Khader, Abdullah A; Absy, M.; Al-Hasani, M K; Joyce, Brian T.; Sabbagh, Taher

doi:10.1097/00007890-198805000-00030

Cited by 31 publications

(5 citation statements)

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“…As reported by other authors (Al‐Khader 1988; Pikrell 1988; Tyden 1988), cyclosporin markedly increases the incidence of IUGR. In our series, the miscarriage rate was also increased when cyclosporin was used.…”

Section: Discussionsupporting

confidence: 82%

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: Discussionsupporting

confidence: 82%

Pregnancy after renal transplantation: 25 years experience in Spain

Cararach¹,

Carmona²,

Monleón³

et al. 1993

BJOG

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“…In human cardiac transplant patients treated with cyclosporine, there is circumstantial evidence for cholestasis. Schade and colleagues have observed that levels of total and direct bilirubin are significantly elevated in these patients compared to their preoperative values [8]. It is also possible, though not proven, that an as yet undefined primary lithogenic quality inherent to cyclosporine exists.…”

mentioning

confidence: 99%

Optimal timing and indications for cholecystectomy in cardiac transplant patients

et al. 1995

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Cardiac transplant is performed with increasing frequency as the treatment for end-stage cardiac disease. Although cholelithiasis is more frequent in both pretransplant and posttransplant patients, no standard management approach exists. Because many such patients are cared for outside the transplant center, it is important that general surgeons develop an appropriate strategy to manage this entity. We present our experience with 11 patients from our institution who underwent cholecystectomy before or after cardiac transplantation. In addition, we have reviewed the 76 reported cases of cholecystectomy performed in precardiac or postcardiac transplant patients from centers throughout the world. Any procedure in this patient group requires critical consideration in regard to the timing and type of procedure. Pretransplant patients are well recognized cardiac risks, and posttransplant immunosuppressed patients are at considerable risk for septic complications. Six patients underwent cholecystectomy prior to heart transplant. Five were performed laparoscopically, one as an open procedure. We also report five laparoscopic cholecystectomies in patients after cardiac transplant. One patient in the pretransplant group died 7 days after surgery from an uncontrollable arrhythmia. There were no hemodynamic or septic complications in either group. Current summated experience (87 cases) indicates that the mortality rate for urgent cholecystectomy in the posttransplant group is at least 36%. Because the first presentation of gallstones in this population is often acute cholecystitis, asymptomatic calculi cannot be considered benign. Elective cholecystectomy, laparoscopic or open, is tolerated well both before and after transplant. Given these facts, it seems reasonable to recommend pretransplant screening and posttransplant surveillance for gallstones.(ABSTRACT TRUNCATED AT 250 WORDS)

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“…53 Cyclosporine therapy has not been associated with an increased risk of congenital malformations in both animal studies and human case reports; however, its use may be associated with an increased risk of low birth weight and preterm delivery. [56][57][58][59][60][61] Nephrotoxicity, a drug side-effect in adults, has been identified in animal offspring exposed prenatally to cyclosporines. Breastfeeding is not recommended during cyclosporine treatment.…”

Section: Inflammatory Bowel Disease In Pregnancymentioning

confidence: 99%

Gastrointestinal Conditions during Pregnancy

Longo

Moore

Canzoneri

et al. 2010

Clinics in Colon and Rectal Surgery

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Pregnancy causes anatomic and physiologic changes in the gastrointestinal tract. Pregnant women with intestinal disease such as Crohn disease or ulcerative colitis pose a management challenge in clinical diagnosis, radiologic evaluation, and treatment secondary to potential risk to the fetus. Heightened physician awareness on possible etiologies such as appendicitis, diverticulitis, and rarely colorectal cancer is required for rapid diagnosis and treatment to improve maternal/fetal outcome. A multidisciplinary approach to evaluation is a necessity because radiologic procedures and treatment medications commonly used in nonpregnant patients may have a potential harmful effect on the fetus. The authors review several gastrointestinal conditions encountered during pregnancy and address presentation, diagnosis, and treatment of each condition.

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Successful Pregnancy in Renal Transplant Recipients Treated With Cyclosporine

Cited by 31 publications

References 0 publications

Pregnancy after renal transplantation: 25 years experience in Spain

Pregnancy after renal transplantation: 25 years experience in Spain

Optimal timing and indications for cholecystectomy in cardiac transplant patients

Gastrointestinal Conditions during Pregnancy

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