Document Detail


Report from the National Transplantation Pregnancy Registry (NTPR): outcomes of pregnancy after transplantation.
MedLine Citation:
PMID:  11038629     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Specific data on pregnancies following transplantation continue to accrue in the National Transplantation Pregnancy Registry (NTPR) in each type of organ recipient, with the following conclusions: 1. While the majority of kidney recipients appear to tolerate pregnancy well, a small percentage develops rejection, graft dysfunction and/or graft deterioration. Overall, there is a slight increase in the mean postpartum creatinine level when compared with the prepregnancy level, which has been noted in previous investigations by the NTPR. One neonatal death attributed to thrombotic cardiomyopathy was noted in a set of twins of a tacrolimus-based kidney recipient, but no other death has been noted in any of the additional reports among the recipients given newer immunosuppression regimens. Follow-up of offspring of these recipients is ongoing. 2. No structural malformations have been noted among offspring exposed to mycophenolate mofetil, but exposures are limited. (5 mothers, 29 fathers). 3. Female liver recipients with biopsy-proven acute rejection during pregnancy appear to be at greater risk for both poorer newborn outcomes and recurrent rejection episodes. In the setting of acute rejection diagnosed during pregnancy, close attention is warranted, anticipating that birthweight may be lower and that a substantial percentage of these female recipients may have recurrent rejection episodes. 4. Pancreas-kidney grafts can maintain normoglycemia throughout pregnancy. A high incidence of maternal hypertension, prematurity and low birthweight have been noted, so, as in other recipient groups, these are high-risk pregnancies. Maternal pancreas and kidney function must be closely monitored. 5. No specific prepregnancy predictors of adverse outcomes have yet been identified among heart or lung recipients although none of the deaths among heart recipients in the NTPR database occurred within 2 years of delivery. When compared with other solid organ recipients, female lung recipients may face higher risks, particularly related to rejection. Whether prepregnancy factors can help to predict either heart or lung recipients at risk requires continued study. 6. No structural malformations or significant learning disabilities have been noted in follow-up of the offspring of CsA-treated females, the largest group of offspring followed to date with a mean age of 4-5 years. Continued surveillance of children will be essential to determine if effects become apparent as age-related developmental delays or other problems in immune function or fertility later in life. 7. Newer regimens as well as new combinations of agents will continue to be studied. It is essential that non-viable as well as viable pregnancy outcomes be reported to the registry (i.e., recipients with pregnancies that result in spontaneous abortion or termination should be included for study). True estimates of non-viable outcomes have been difficult to assess. Additionally, inclusion of reports of pathologic evaluations at delivery hospitals will be helpful to determine whether spontaneous abortions are a result of lethal malformations related to immunosuppressive or other medication exposure. Safety of pregnancy for parent and child remain the primary goals of the NTPR.
Authors:
V T Armentl; G A Wilson; J S Radomski; M J Moritz; C H McGrory; L A Coscia
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Clinical transplants     Volume:  -     ISSN:  0890-9016     ISO Abbreviation:  Clin Transpl     Publication Date:  1999  
Date Detail:
Created Date:  2000-10-25     Completed Date:  2000-11-15     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  8812419     Medline TA:  Clin Transpl     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  111-9     Citation Subset:  IM    
Affiliation:
National Transplantation Pregnancy Registry (NTPR), Department of Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
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MeSH Terms
Descriptor/Qualifier:
Abortion, Spontaneous / epidemiology
Abortion, Therapeutic / statistics & numerical data
Female
Fetal Death
Graft Rejection / epidemiology
Humans
Infant, Newborn
Kidney Transplantation / physiology
Liver Transplantation / physiology
Male
Organ Transplantation*
Pancreas Transplantation / physiology
Pregnancy
Pregnancy Complications / classification,  physiopathology*
Pregnancy Outcome*
Questionnaires
Registries*
United States

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


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