Document Detail


Management of pregnancy in transplant recipients.
MedLine Citation:
PMID:  15518723     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Transplantation offers the best prospect of pregnancy in fertile women with various types of end-stage organ disease. Based on data from the USA National Transplantation Pregnancy Registry, >70% of posttransplant pregnancies have a successful live birth. Greatest experience has been seen in transplants involving the kidney, followed by the liver and then heart. Most pregnancies do not affect graft function significantly but are associated with significant obstetric problems such as spontaneous abortions, premature deliveries, low birthweight, intrauterine growth retardation, preeclampsia, etc. Cesarian section is required in 30% to 50% of patients, due to obstetric or maternal concerns. Neonatal death is rare, but 30% to 50% of live births have complications. Thus, management requires a multidisciplinary team. Similar data have been documented in developed Asian countries such as Japan and Singapore. Although fertility is restored early (<6 months), the current recommendation is to wait for >/=1 year, if not 2 years, after transplantation before allowing pregnancy. Patients without evidence of graft dysfunction and hypertension are more likely to have successful outcomes. Acute rejections may occur but the incidence does not appear to be increased dramatically. Treatment should be to similar to that of nonpregnancy treatment. Further pregnancies may be considered in instances of good outcome for the graft, fetus, and mother. Significant experience and safety has been accumulated in treatment using cyclosporine, azathioprine, prednisolone, and tacrolimus. However, few data are available with regard to the newer immunosuppressants, such as mycophenolate mofetil, and thus these agents are not recommended. Most live births have normal growth and development. Although there is much information available on posttransplant pregnancy it is imperative that each center maintains its own registry of pregnancy and offspring outcomes.
Authors:
P Sivaraman
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Transplantation proceedings     Volume:  36     ISSN:  0041-1345     ISO Abbreviation:  Transplant. Proc.     Publication Date:  2004 Sep 
Date Detail:
Created Date:  2004-11-02     Completed Date:  2005-04-14     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0243532     Medline TA:  Transplant Proc     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1999-2000     Citation Subset:  IM    
Affiliation:
Department of Medicine, National University Hospital, Singapore. pary_s@nuh.com.sg
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MeSH Terms
Descriptor/Qualifier:
Female
Humans
Immunosuppressive Agents / adverse effects,  therapeutic use
Pregnancy
Pregnancy Complications / etiology*
Pregnancy Complications, Infectious / epidemiology
Pregnancy Outcome
Registries
Transplantation* / statistics & numerical data
United States
Chemical
Reg. No./Substance:
0/Immunosuppressive Agents

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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