SOLİD ORGAN (BÖBREK, KARACİĞER, PANKREAS-BÖBREK, KALP, AKCİĞER VE KALP-AKCİĞER) TRANSPLANTASYONU VE GEBELİK

Yıl 2008, Cilt: 21 Sayı: 1, 79 - 88, 24.06.2015

Yusuf Yıldırım Seyhan Sönmez Emrah Toz Murat İnal Ahmet Aykas Adam Uslu

Öz

Reprodüktif çağdaki kadınlarda solid organ transplantasyonu sıklığı ve çeşitliliği her geçen yıl artmaktadır.
Transplantla ilişkili gebeliklerin çoğu böbrek allogreftli kadınlarda bildirilmesine rağmen; karaciğer,
pankreas-böbrek, kalp, akciğer ve kalp-akciğer transplantları gibi diğer solid organ transplantlı genç
kadınlarda da gebelik mümkündür. Bu gebeliklerin çoğu başarılı bir akibetle sonuçlanmaktadır; bununla
birlikte, optimal maternal ve neonatal sonuç için, obstetrisyen ve transplant ekibinin dikkatli takiplerini
içeren multidisipliner bir yaklaşım esastır. Bu çalışma National Transplantation Pregnancy Registry
(NTPR)’ninkiler başta olmak üzere daha önce yayınlanmış raporları göz önünde bulundurarak, çeşitli solid
organ transplantlı kadınlarda prekonsepsiyonel danışmanlık, gebelik sırasında greft rejeksiyonu ve
disfonksiyonu, immunsupresif tedavinin fetus açısından güvenilirliği ve perinatal riskler ve gebelik
yönetimini gözden geçirmekte ve tartışmaktadır.

Anahtar Kelimeler

Solid Organ Transplantasyonu, Gebelik, Komplikasyonlar

SOLID ORGAN (KIDNEY, LIVER, PANCREAS-KIDNEY, HEART, LUNG AND HEARTLUNG) TRANSPLANTATIONS AND PREGNANCY

Öz

The frequency and variety of solid organ transplantation in reproductive-age women increases each year. Although most transplant-related pregnancies have been reported in women with kidney allografts, pregnancy is also possible in young women with other solid organ transplants including liver, pancreaskidney, heart, lung and heart-lung transplants. Most of these pregnancies have resulted in a successfull outcome; however, for optimal maternal and neonatal outcomes, a multidisciplinary approach including careful follow-ups of the obstetrician and transplant team is essential. This article reviews and discusses preconceptional counselling, graft rejection and dysfunction during pregnancy, safety of immunosuppressive medications with regard to fetus, and perinatal risks and pregnancy management for women with various solid organ transplants, taking into consideration previous published reports, especially The National Transplantation Pregnancy Registry (NTPR)’s

Anahtar Kelimeler

Solid Organ Transplantation, Pregnancy, Complications

Kaynakça

• 1. Yildirim Y, Tinar S, Yildirim YK, Inal M. Comparison of pituitary-ovarian function in patients who have undergone successful renal transplantation and healthy woman. Fertil Steril 2005; 83: 1553-6
• 2. Yildirim Y, Uslu A. Pregnancy after successful renal transplantation. Int J Gynecol Obstet 2005; 90: 198- 202
• 3. Murray JE, Reid DE, Harrison JH, Merrill JP. Successful pregnancies after human renal transplantation. N Engl J Med 1963; 269-341
• 4. Saha MT, Saha HH, Niskanen LK, Salmella KT, Pasternack AI. Time course of serum prolactin and sex hormones following successful renal transplantation. Nephron 2002; 92: 735-7
• 5. McKay DB, Josephson MA, Armenti VT, August P, Coscia LA, Davis CL, et al. Reproduction and Transplantation: Report on the AST Consensus Conference on Reproductive Issues and Transplantation. Am J Transplant 2005; 5: 1592-9
• 6. Armenti VT, Radomski JS, Moritz MJ, Gaughan WJ, Philips LZ, McGrory CH, et al. Report from the National Transplant Pregnancy Registry (NTPR): outcomes of pregnancy after transplantation. Clin Transplant 2001; 97-105
• 7. Gaughan WJ, Moritz MJ, Radomski JS, Burke Jr JF, Armenti VT. NationalTransplantation Pregnancy Registry: report on outcomes in cyclosporine-treated female kidney transplant recipients with an interval from transplant to pregnancy of greater than five years. Am J Kidney Dis 1996; 28: 266-9
• 8. Davison JM. The effect of pregnancy on kidney function in renal allograft recipients. Kidney Int 1985; 27: 74-9
• 9. Casele HL, Laifer SA. Pregnancy after liver transplantation. Semin Perinatol 1998; 22: 149-55
• 10. Shlay JC, Mayhugh B, Foster M, Maravi ME, Baron AE, Douglas JM. Initiating contraception in sexually transmitted disease clinic setting: a randomized trial. Am J Obstet Gynecol 2003; 189: 473-81
• 11. Laifer SA, Guido RS. Reproductive function and outcomes of pregnancy after liver transplantation in women. Mayo Clin Proc 1995; 70: 388-94
• 12. Mastrobattista JM, Katz AR. Pregnancy after organ transplant. Obstet Gynecol Clin N Am 2004; 31: 415- 28
• 13. Cardonick E, Moritz M, Armenti V. Pregnancy in patients with organ transplantation: A review. Obstet Gynecol Surv 2004; 59: 214-22
• 14. Jonas S, Rayes N, Neumann U, Neuhaus R, Bechstein WO, Guckelberger O, et al. De novo malignancies after liver transplantation using tacrolimus-based protocols or cyclosporine-based quadruple immunosuppression with an interleukine-2 receptor antibody or antithymocyte globulin. Cancer 1997; 80: 1141-50
• 15. Hou S. Pregnancy in renal transplant recipients. Adv Ren Replace Ther 2003; 10: 40-7
• 16. Morini A, Spina V, Aleandri V, Cantonetti G, Lambiasi A, Papalia U. Pregnancy after heart transplant: update and case report. Hum Reprod 1998; 13: 749-57
• 17. Davison JM, Bailey DJ. Pregnancy following renal transplantation. J Obstet Gynaecol Res 2003; 29: 227- 33
• 18. Kuvacic I, Sprem M, Skrablin S, Kalafatic D, BubicFlipi L, Milici D. Pregnancy outcome in renal transplant recipients. Int J Gynaecol Obstet 2000; 70: 313-7
• 19. Armenti VT, Ahlswede BA, Moritz. National Transplantation Pregnancy Registry: analysis of pregnancy outcomes of female kidney recipients with relation to time interval from transplant to conception. Transplant Proc 1993; 25: 1036-7
• 20. Davison JM, Milne JE. Pregnancy and renal transplantation. Br J Urol 1997; 80: 29-32
• 21. Crowe AV, Rustom R, Gradden C, Sells RA, Bakran A, Bone JM, et al. Pregnancy does not adversely affect renal transplant function. QJM 1999; 92: 631-5
• 22. Tan PK, Tan AS, Tan HK, Vathsala A, Tay SK. Pregnancy after renal transplantation: experience in Singapore General Hospital. Ann Acad Med Singapore 2002; 31: 285-9
• 23. Davison JM. Dialysis, transplantation and pregnancy. Am J Kidney Dis 1991; 17: 127-32
• 24. Hou S. Pregnancy in chronic renal insufficiency and end-stage renal disease. Am J Kidney Dis 1999; 33: 235-55
• 25. Robinson R. The fetal origins of adult disease. BMJ 2001; 322: 375-6
• 26. Nagy S, Bush MC, Berkowiitz R, Fishbein TM, Gomez-Lobo V. Pregnancy outcome in liver transplant recipients. Obstet Gynecol 2003; 102: 121- 8
• 27. Vielle Y, Fernandez H , Samuel D, Bismuth H, Frydman R. Pregnancy in liver transplant recipients: course and outcome in 19 cases. Am J Obstet Gynecol 1993; 168: 896-902
• 28. Armenti VT, Radomski JS, Moritz MJ, Gaughan WJ, Hecker WP, Lavelanet A, et al. Report from the National Transplant Pregnancy Registry (NTPR): outcomes of pregnancy after transplantation. Clin Transplant 2004; 103-14
• 29. Wasywich CA, Ruygrok PN, Wilkinson L, Gibbs H, Coverdale HA. Planned pregnancy in a heart transplant recipient. Intern Med J 2004; 34: 206-9
• 30. Szekeres-Bartho J, Csernus V, Hadnagy J, Pasca AS. Immunosuppressive effect of serum progesterone during pregnancy depends on the progesterone binding capacity of the lymphocytes. J Reprod Immunol 1983; 5: 81-8
• 31. Hou S. Pregnancy in transplant recipients. Med Clin North Am 1989; 73: 667-83
• 32. Davison JM. Towards long-term graft survival in renal transplantation: Pregnancy. Nephrol Dial Transplant 1995; 10: 85-9
• 33. Armenti VT, Moritz MJ, Radomski JS. Pregnancy and transplantation. Graft 2000; 3: 59-63
• 34. Scott JR, Wagoner LE. Olsen SL, Taylor DO, Renlund DG. Pregnancy in heart transplant recipients: Management and outcome. Obstet Gynecol 1993; 82: 324-7
• 35. Donaldson S, Novotny D, Rparadowski L, Aris R. Acute and chronic lung allograft rejection during pregnancy. Chest 1996; 110: 293-6
• 36. Armenti VT, Moritz MJ, Cardonick EH, Davison JM. Immunosuppression in pregnancy: choices for infant and maternal health. Drugs 2002; 62: 2361-75
• 37. Ventura A, Martins L, Dias L, Henriques AC, Sarmento AM, Braga J, et al. Pregnancy in renaltransplant recipients. Transplant Proc 2000; 32: 2611-2
• 38. Bar J, Stahl B, Hod M, Wittenberg C, Pardo J, Merlob P. Is immunosuppression therapy in renal allograft recipientsteratogenic? A single-center experience. Am J Med Genet 2003; 116: 31-6
• 39. Le Ray C, Coulomb A, Elefant E, Frydman R, Audibert F. Mycophenolate mofetil in pregnancy after renal transplantation: a case of major fetal malformations. Obstet Gynecol 2004; 103: 1091-4
• 40. Scott JR, Branch DW, Holman J. Autoimmune and pregnancy complications in daughter of kidney transplant patient. Transplantation 2002, 73: 815-6
• 41. Albengres E, Louet HL, Tillement JP. Immunosuppressive drugs and pregnancy: Experimental and clinical data. Transplant Proc 1997; 29: 2461-6
• 42. Stempfle HU, Werner C, Echtler S, Wehr U, Rambeck WA, Siebert U, et al. Prevention of osteoporosis after cardiac transplantation: A prospective, longitudinal, randomized, double-blind trial with calcitriol. Transplantation 1999; 68: 523-30
• 43. Birkeland SA. Steroid-free immunosuppression in renal transplantation: a long-term follow-up of 100 consecutive patients. Transplantation 2001; 71: 1089- 90
• 44. Armenti VT, Moritz MJ, Davison JM. Drug safety issues in pregnancy following transplantation and immunosuppression. Effects and outcomes. Drug Safety 1998; 19: 219-32
• 45. Jain A, Venkataramanan R, Fung JJ, Gartner JC, Lever J, Balan V, et al. Pregnancy afer liver transplantation under tacrolimus. Transplantation 1997; 64: 559-65
• 46. Vyas S, Kumar A, Piecuch S, Hidalgo G, Singh A, Anderson V, et al. Outcome of twin pregnancy in a renal transplant recipient treated with tacrolimus. Transplantation 1999; 67: 490-5