Pregnancy in women with solid-organ transplants

Czech version

Authors: M. Nováčková ^1,2; Z. Pastor ¹; J. Matěcha ¹; M. Čekal ¹; J. Froněk ¹; R. Chmel ^1,2
Authors‘ workplace: Gynekologicko-porodnická klinika 2. LF UK a FN Motol, Praha, přednosta doc. MUDr. L. Rob, CSc. ¹; Klinika transplantační chirurgie IKEM, Praha, přednosta doc. MUDr. J. Froněk, Ph. D., FRCS, MHA ²
Published in: Ceska Gynekol 2018; 83(1): 62-68

Overview

Objective:
Evaluation of pregnancies and deliveries in women after solid organ transplantations with respect to the maternal and fetal risks.

Design:
Overview article.

Setting:
Department of Obstetrics and Gynaecology, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague.

Methods:
Literature search using the Web of Science, Ovid, Cochrane, Google Scholar and Medline databases with keywords (transplantation, pregnancy, immunosuppression) and analysis of articles published in impact and reviewed journals from 1958 to 2017.

Results:
Pregnancy in patients after solid organ transplantions is associated with the higher risk of complications, particularly preeclampsia, and high incidence of comorbidities. Women after transplantation have an increased risk of premature deliveries and low birth weight newborns. The highest risk of complications is documented after lung transplantation. For immunosuppression in pregnancy inhibitors of calcineurin, azathioprine and prednisone are used.

Conclusion:
Pregnancies and deliveries in women after solid organ transplants are in a high risk. With early transplantation, adequate patient health compensation, properly planned pregnancy, adequate immunosuppressive therapy and specialized prenatal and obstetric care, women can give birth to healthy newborns after transplantation.

Keywords:
pregnancy, delivery, transplantation, immunosuppression

Sources

1. 50 let transplantací ledvin - půl století na cestě k životu. Medical tribune, 2016, 6. http://www.tribune.cz/clanek/39043-let-transplantaci-ledvin-pul-stoleti-na-ceste-k-zivotu.

2. Armenti, VT., Moritz, MJ., Cardonick, EH., Davison, JM. Immunosuppression in pregnancy: choices for infant and maternal health. Drugs, 2002, 62(16), p. 2361–2375.

3. Barnard, CN. Human heart transplantation. Can Med Assoc J, 1969, 100(3), p. 91–104.

4. Bay Bjorn, AM., Ehrenstein, V., Hundborg, HH., et al. Use of corticosteroids in early pregnancy is not associated with risk of oral clefts and other congenital malformations in offspring. Am J Ther, 2014, 21(2), p. 73–80.

5. Bramham, K., Nelson-Piercy, C., Gao, H. Pregnancy in renal transplant recipients: a UK national cohort study. Clin J Am Soc Nephrol, 2013, 8(2), p. 290–298.

6. Brännström, M., Johannesson, L., Bokström, H., et al. Livebirth after uterus transplantation. Lancet, 2015, 385(9968), p. 607–616.

7. Constantinescu, S., Pai, A., Coscia, LA., et al. Breast-feeding after transplantation. Best Pract Res Clin Obstet Gynaecol, 2014, 28(8), p. 1163.

8. Coscia, LA., Constantinescu, S., Moritz, MJ., et al. Report from the National Transplantation Pregnancy Registry (NTPR): outcomes of pregnancy after transplantation. Clin Transpl, 2010, p. 65–85.

9. Coscia, LA., Constantinescu, S., Moritz, MJ., et al. Report from the National Transplantation Pregnancy Registry (NTPR): outcomes of pregnancy after transplantation. Clin Transpl, 2009, p. 103–122.

10. Deshpande, NA., Coscia, LA., Gomez-Lobo, V., et al. Pregnancy after solid organ transplantation: a guide for obstetric management. Rev Obstet Gynecol, 2013, 6(3–4), p. 116–125.

11. Deshpande, NA., James, NT., Kucirka, LM., et al. Pregnancy outcomes of liver transplant recipients: a systematic review and meta-analysis. Liver Transpl, 2012, 18(6), p. 621–629.

12. Deshpande, NA., James, NT., Kucirka, LM., et al. Pregnancy outcomes in kidney transplant recipiens: a systematic review and meta-analysis. Am J Transplant, 2011, 11, p. 2388–2404.

13. Durst, JK., Rampersad, RM. Pregnancy in women with solid-organ transplants: a review. Obstet Gynecol Surv, 2015, 70(6), p. 408–418.

14. Fageeh, W., Raffa, H., Jabbad, H., Marzouki, A. Transplantation of the human uterus. Int J Obstet Gynecol, 2002, 76, p. 245–251.

15. Goldstein, LH., Dolinski, G., Greenberg, R., et al. Pregnancy outcome of women exposed to azathioprine during pregnancy. Birth Defects Res A Clin Mol Teratol, 2007, 79(10), p. 696–701.

16. Gorgulu, N., Yelken, B., Caliskan, Y., et al. Does pregnancy increase graft loss in female renal allograft recipiens? Clin Exp Nephrol, 2010, 14, p. 244–247.

17. Gyi, KM., Hodson, ME., Yacoub, MY. Pregnancy in cystic fibrosis lung transplant recipiens: Case series and review. J Cyst Fibros, 2006, 5(3), p. 171–175.

18. Humlová, D. Žena s transplantovaným srdcem porodila zdravou holčičku. Nemocniční listy. Fakultní nemocnice Brno. 2016, 1, s. 20.

19. Chhabria, S. Aicardi´s syndrome: are corticosteroids teratogens? Arch Neurol, 1981, 38(1), p. 70.

20. Chmel, R., Nováčková, M., Pastor, Z., et al. Možnosti transplantace dělohy v České republice – indikace, výzkum a klinické zkušenosti. Čas Lék čes, 2017, 156(1), s. 28–35.

21. Johnson, MR., Naftel, DC., Hobbs, RE., et al. The incremental risk of female sex in heart transplantation: a multiinstitutional study of peripertum cardiomyopathy and pregnancy. Cardiac Transplant Research Database Group. J Heart Lung Transplant, 1997, 16(8), p. 801–812.

22. Kanbay, M., Akcay, A., Huddam, B. Influence of cyclosporine and tacrolimus on serum uric acid levels in stable kidney transplant recipients. Transplant Proc, 2005, 37(7), p. 3119–3120.

23. Kashanizadeh, N., Nemati, E., Sharifi-Bonab, M., et al. Impact of pregnancy on the outcome of kidney transplantation. Transplant Proc, 2007, 39, p. 1136–1138.

24. Kim, M., Rostas, S., Gabardi, S. Mycophenolate fetal toxicity and risk evaluation and mitigation strategies. Am J Transplant, 2013, 13(6), p. 1383–1389.

25. Kim, HW., Seok, HJ., Kim, TH. The experience of pregnancy after renal transplantation: pregnancies even within postoperative 1 year may be tolerable. Transplantation, 2008, 85(10), p. 1412–1419.

26. Koordinační středisko transplantací. Dostupné na www.kst.cz.

27. Kořístek, V., Černý, J., Gregor, Z., et al. Naše první zkušenosti s klinickou transplantací jater. Čas Lék čes, 1984, 123, s. 93–96.

28. Levidiotis, V., Chang, S., McDonald, S., et al. Pregnancy and maternal outcomes among kidney transplant recipients. J Am Soc Nephrol, 2009, 20, p. 2433–2440.

29. Löwenstein, BR., Vain, NW., Perrone, SV., et al. Successful pregnancy and vaginal delivery after heart transplantation. Am J Obstet Gynecol, 1988, 158, p. 589–590.

30. Majak, GB., Sandven, I., Lorentzen, B. Pregnancy outcomes following maternal kidney transplantation: a national cohort study. Acta Obstet Gynecol Scand, 2016, 95(10), p. 1153–1161.

31. McKay, DB., Josephson, MA. Pregnancy after kidney transplantation. Clin J Am Soc Nephrol, 2008, 3, Suppl. 2, p. 117–125.

32. McKay, DB., Josephson, MA. Pregnancy in recipients of solid organs – effect on mother and child. N Engl Med, 2006, 354, p. 1281.

33 McKay, DB., Josephson, MA., Armenti, VT., et al. Reproduction and transplantation: report on the AST Consensus Conference on Reproductive Issues and Transplantation. Am J Transplant, 2005, 5(7), p. 1592–1599.

34. Mohamed-Ahmed, O., Nelson-Piercy, C., Bramham, K., et al. Pregnancy outcomes in liver and cardiothoracic transplant recipients: a UK national cohort study. PLoS One, 2014, 9(2), e89151.

35. Morales, JM., Hernández Poblete, G., Andrés, A., et al. Uric acid handling, pregnancy and cyclosporin in renal transplant women. Nephron, 1990, 56(1), p. 97–98.

36. Moritz, MJ., Coscia, LA., Armenti, DP., Constantinescu, S. National Transplantation Pregnancy Registry: Cholestasis of pregnancy in liver transplant recipients. Am J Transplant, 2015, 15, p. 110A.

37. Murray, JE., Reid, DE., Harrison, KH., et al. Successful pregnancies after human renal transplantation. Engl J Med, 1963, 269, p. 341–343.

38. Murray, JE., Merrill, JP., Harrison, JH. Kidney transplantation between seven pairs of identical twins. Ann Surg, 1958, 148(3), p. 343–359.

39. Natekar, A., Pupco, A., Bozzo, P., Koren, G. Safety of azathioprine use during pregnancy. Can Fam Physician, 2011, 57(12), p. 1401–1402.

40. National Transplantation Pregnancy Registry. 2015 Annual report. Zpráva je dostupná na www.ntpr.giftoflifeinstitute.org.

41. Nevers, W., Pupco, A., Koren, G., Bozzo, P. Safety of tacrolimus in pregnancy. Can Fam Physician, 2014, 60(10), p. 905–906.

42. Pafko, P., Kabát, J., Schützner, J., et al. První transplantace plic v České republice. Rozhl Chir, 1999, 78(4), s. 148–149.

43. Parry, D., Hextall, A., Robinson, VP., et al. Pregnancy following a single lung transplant. Thorax, 1996, 51, p. 1162–1164.

44. Pastor, Z., Fronek, J., Novackova, M., Chmel, R. Sexual life of women with Mayer-Rokitanski-Küster-Hauser syndrome after laparoscopic Vecchietti vaginoplasty. Sex Med, 2017, 5(2), p. 106–113.

45. Rocha, A., Cardoso, A., Malheiro, J., et al. Pregnancy after kidney transplantation: graft, mother, and newborn complications. Transplant Proc, 2013, 45(3), p. 1088–1091.

46. Saarikoski, S., Seppälä, M. Immunosuppression during pregnancy: transmission of azathioprine and its metabolites from the mother to the fetus. Am J Obstet Gynecol, 1973, 115(8), p. 1100–1106.

47. Scott, JR., Branch, DW., Holman, J. Autoimmune and pregnancy complications in the daughter of a kidney transplat patient. Transplantation, 2002, 73, p. 815–816.

48. Shah, S., Verma, P. Overview of pregnancy in renal transplant patients. Int J Nephrol, 2016;2016:4539342. doi: 10.1155/2016/4539342.

49. Sibanda, N., Briggs, JD., Davison, JM., et al. Pregnancy after organ transplantation: a report from the UK Transplant pregnancy registry. Transplantation, 2007, 83(10), p. 1301–1307.

50. Sifontis, NM., Coscia LA., Constantinescu, S., et al. Pregnancy outcomes in solid organ transplant recipients with exposure to mycophenolate mofetil or sirolimus. Transplantation, 2006, 82(12), p. 1698–1702.

51. Starzl, TE., Groth, CG., Brettschneider, L. Orthotopic homotransplantation of the human liver. Ann Surg, 1968, 168, p. 852–856.

52. Thakrar, MV., Morley, K., Lordan, JL. Pregnancy after lung and heart-lung transplantation. J Heart Lung Transplant, 2014, 33(6), p. 593–598.

53. Vlk, R., Matěcha, J., Drochýtek, V. Prevence preeklampsie – přehledový článek. Čes Gynek, 2015, 80(3), s. 229–235.

54. Walcott, WO., Derick, DE., Jolley, JJ., Snyder, DL. Succsessful pregnancy in a liver transplant patient. Am J Obstet Gynecol, 1978, 132, p. 340–341.

55. Wielgos, M., Pietrzak, B., Bobrowska, K., et al. Pregnancy after organ transplantation. Neuro Endocrinol Lett, 2009, 30(1), p. 6–10.

56. Willis, FR., Findlay, CA., Gorrie, MJ., et al. Children of renal transplant recipient mothers. J Paediatr Child Health, 2000, 36, p. 230–235.

57. Yamamura, M., Kojima, T., Koyama, M., et al. Everolimus in pregnancy: Case report and literature review. J Obstet Gynecol Res, 2017, 43(8), p. 1350–1352.

58. Zheng, S., Easterling, TR., Hays, K. Tacrolimus placental transfer at delivery and neonatal exposure through breast milk. Br J Clin Pharmacol, 2013, 76(6), p. 988–996.

59. Živný, J., Adamec, M., Pařízek, A., et al. Těhotenství a porod po kombinované transplantaci ledviny a pankreatu v České republice. Čes Gynek, 2005, 70(5), s. 362–366.