Can a woman get pregnant after a kidney transplant
The most common problem is preeclampsia, which is a type of high blood pressure during pregnancy. Doctors need more research to better understand how kidney donation affects pregnancy and giving birth. It may be best to donate before becoming pregnant, but it is possible to donate after having a baby. Pregnancy and birth after kidney donation: the Norwegian experience. Am J Transplant. Pregnancy outcomes after kidney donation.
SEE VIDEO BY TOPIC: Fertility and Pregnancy in Transplantation - UCSF Kidney Transplant ProgramContent:
- Pregnancy outcomes in women with kidney transplant: Metaanalysis and systematic review
- Pregnancy after kidney transplant has risks, but can succeed, study says: Healthy Cleveland
- Having Children after Transplant? 10 Frequently Asked Questions
- Successful pregnancy possible after kidney transplant
- House Organ
- Kidney Transplant in pregnancy
- How living kidney donation can affect pregnancy
- Kidney disease and pregnancy: It’s challenging, but possible
Pregnancy outcomes in women with kidney transplant: Metaanalysis and systematic review
Women with chronic renal failure suffer from loss of libido, anovulatory vaginal bleeding or amenorrhea and high prolactin levels [ 1 ]. On dialysis most experience decreased libido and reduced ability to reach orgasm [ 2 — 4 ]. Conception is rare for women on dialysis. It occurs at a rate of no more than one in every patients [ 5 ]. Fertility is usually restored in women with renal transplants. The recovery of fertility is less common in women who undergo transplantation close to the end of their childbearing years [ 3 ].
The first reported successful pregnancy occurred in a recipient of a kidney transplant from an identical twin sister performed in [ 7 ]. Since then, there have been hundreds of successful pregnancies reported in renal transplant recipients [ 8 ]. Pregnancy causes an increase in the glomerular filtration rate. In theory, this could lead to hyperfiltration and glomerulosclerosis. However, the hyperfiltration of pregnancy is related to increased plasma flow, with no concomitant increase in intraglomerular pressure [ 9 ].
Overall, in the majority of recipients studied, pregnancy does not appear to cause excessive or irreversible problems with graft function if the function of transplant organ is stable prior to pregnancy [ 11 ]. Currently, we have limited information regarding the toxicities and teratogenic potentials of these agents, although our knowledge has recently increased as more women maintained on immunosuppressive therapy for solid organ transplants have opted to become pregnant.
The most commonly used glucocorticoids are the short acting agents; prednisone, prednisolone and methyl prednisolone. Cases of cleft palate or mental retardation have also been described in humans after in utero corticosteroid exposure [ 14 ]. Steroids may be implicated in the increased frequency of premature rupture of membranes of transplant recipients.
They can also aggravate hypertension in the mother. Treatment of rejection with steroids, if necessary, is not contraindicated, however, during pregnancy. Azathioprine is used during pregnancy in many transplant recipients. The immature fetal liver lacks the enzyme inosinate pyrophosphorylase needed for conversion, and the fetus is relatively protected from the effects of the drug.
In human studies low birth weights, prematurity, jaundice, respiratory distress syndrome and aspiration have been reported in kidney transplant recipients.
There is little or no transplacental passage of cyclosporin in rodents [ 17 ]. In comparison, there are conflicting reports on the transfer of cyclosporin across the human placenta.
Studies in pregnant rats have generally shown no effect of cyclosporin on organogenesis, although some renal proximal tubular cell damage can occur [ 18 ]. Human data showed that adminstration of cyclosporin was associated with low birth weights and a higher incidence of maternal diabetes, hypertension and renal allograft dysfunction.
Cyclosporin metabolism appears to be increased during pregnancy and higher doses may be required to maintain plasma levels in the therapeutic range [ 19 ].
There is a paucity of data concerning the effect of tacrolimus on pregnancy. As with cyclosporin, patients taking tacrolimus require frequent monitoring of renal function and drug levels.
During pregnancy, the hepatic cytochrome P enzymes may be inhibited, which can lead to increased serum level of tacrolimus. There is concern based on animal studies that the risk of birth defect or abortion is increased in pregnant women exposed to MMF. Nevertheless, one recent report showed successful use of MMF during pregnancy. Because precise data are limited at the moment we do not recommend its use [ 11 , 22 ]. The effect of polyclonal antibodies on the developing fetus is not known, but the IgG component would be expected to cross the placenta.
All women of childbearing age should be counselled concerning the possibility and risks of pregnancy after kidney transplantation. Women are usually advised to wait at least 1 year after living related donor transplantation and 2 years after cadaver transplantation.
Contraceptive counselling should begin immediately after transplantation, because ovulatory cycles may begin within 1—2 months of transplantation in women with well functioning grafts. Low dose oestrogen—progesterone oral contraceptive preparations are advised. The risk of infection from the use of intrauterine devices is increased in immunocompromised patients. Criteria that should be ideally met before conception are shown in Table 1. Its safety and efficacy are supported by the results of several randomized trials and by a 7.
Cardiovascular beta blockers, especially atenolol and metoprolol, appear to be safe and efficacious in late pregnancy; but fetal growth retardation has been noted when treatment was started in early or midgestation [ 24 ]. Nifedipine, nicardipine and verapamil have been used in severe hypertension of pregnancy. They do not appear to be associated with any increase in congenital anomalies when used in the first trimester [ 3 ].
Labetalol appears to be as effective as methyldopa, but there is little follow up information on children born to mothers treated with this drug. Exposure to ACE inhibitors during the second and third trimester may be associated with serious adverse fetal effects. Most of these problems relate to disturbances of fetal and neonatal renal function, such as oligohydramnios, neonatal anuria, renal failure and death [ 26 ].
The fetal outcome is generally good in women who present in early pregnancy while taking an ACE inhibitor if the drug is stopped. Continued administration of an ACE inhibitor during pregnancy is contraindicated [ 27 ].
These women should have monthly screening urine cultures [ 28 ], if asymptomatic bacteriuria is present; the patient should be treated for 2 weeks and may be treated with suppressive doses of antibiotics for the rest of the pregnancy.
If there is a need for invasive procedures such as fetal monitoring with scalp electrodes or intrauterine pressure monitoring, prophylactic antibiotics are recommended.
The selection of antibiotics should consider potential fetal toxocity. Penicillins which do not interact with eukaryote metabolism are the preferred antibiotic agents. Infection of the fetus can be diagnosed by culturing the amniotic fluid. Ganciclovir has caused birth defects in animals when administered at twice the human dose [ 3 ]. Herpes simplex virus HSV infection before 20 weeks of gestation is associated with an increased rate of abortion.
A positive HSV cervical culture at term is an indication for Caesarean section. This can minimize the risk for neonatal herpes.
Acyclovir can be safely used in pregnancy [ 29 ]. Vaginal delivery is recommended in most transplant recipient women. Caesarean section should be performed only for standard obstetric reasons.
Care must be taken to avoid fluid overload and infection. At the time of delivery, instrumentation should be minimized. Patients with renal insufficiency may be particularly at risk of water retention secondary to oxytocin. Breastfeeding is discouraged for patients taking any immunosuppressive drugs. These levels can be toxic to a newborn. Similar recommendations exist for tacrolimus or other immunosuppressive agents.
Such planned pregnancies offer to the mother and fetus the best chance of a favourable outcome. Correspondence and offprint requests to : Dr M.
Email: lessanpezeshki bmsu. Pituitary and ovarian dysfunction in women on hemodialysis. Nephron ; 30 : — Chronic renal failure and sexual functioning: clinical status versus objectively assessed sexual response. Nephrol Dial Transplant ; 12 : — Hou S. Pregnancy in chronic renal insufficiency and end stage renal disease.
Am J Kidney Dis ; 33 : — Sexual dysfunction after renal replacement therapy. Am J Kidney Dis ; 35 : — Successful pregnancies in women on renal replacement therapy: report from the EDTA registry.
Nephrol Dial Transplant ; 7 : — Effect of pregnancy on long term function of renal allografta. Am J Kidney Dis ; 19 : — Successful pregnancies after human renal transplantation. N Engl J Med ; : Davison JM. Pregnancy in renal allograft recipients: prognosis and management. Ballier Clin Obstet Gynecol ; 1 : — Baylis C.
Glomerular filtration and volume regulation in gravid animal models. Ballier Clin Obstet Gynecol ; 8 : — Variables affecting birthweight and graft survival in pregnancies in cyclosporine treated female kidney transplant recipients.
Transplantaion ; 59 : — Clin Transplant ; — The transplacental passage of prednisone and prednisolone in pregnancy near term. J Pediatr ; 81 : — Parenthood following renal transplantation. Kidney Int ; 18 : — Chabria S. Aicardi's syndrome: are corticosteroids teratogens?
Pregnancy after kidney transplant has risks, but can succeed, study says: Healthy Cleveland
The National Kidney Foundation encourages all transplant recipients who wish to grow their families to learn more about post-transplant pregnancies. Check out ten of the most frequently asked questions FAQs on the subject. The National Transplantation Pregnancy Registry NTPR studies pregnancy after organ transplantation and has provided information to the transplant community for over 20 years. To date, the NTPR has over 2, participants and some of these transplant recipients are even grandparents! Every post-transplant pregnancy experience is important to the NTPR and healthcare providers and transplant recipients are encouraged to report all past or current pregnancies to the registry.
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Having Children after Transplant? 10 Frequently Asked Questions
Kidney transplantation for end-stage renal disease is now a common procedure worldwide. Many of these women are of reproductive age and become pregnant. They need expert obstetric management since these are high-risk pregnancies with a number of potential complications. Also, virtually all transplant patients have other underlying chronic medical diseases. There are no randomized controlled trials to guide physicians in managing pregnancy in renal allograft recipients. Experience has shown that data from observational studies and voluntary registries can be biased and tend toward more favorable outcomes than actually occur. Important components of care include. It is important to understand and anticipate that previous hypertension, underlying chronic medical disorders and immunosuppressant therapy are factors that commonly predispose these women to infections and pregnancy problems such as preeclampsia, fetal growth restriction, preterm birth and cesarean delivery. Pre-pregnancy counseling for each kidney transplant patient and her spouse is highly desirable.
Successful pregnancy possible after kidney transplant
Metrics details. Reproductive function in women with end stage renal disease generally improves after kidney transplant. However, pregnancy remains challenging due to the risk of adverse clinical outcomes. Of unique studies, 87 met inclusion criteria, representing pregnancies in kidney transplant recipients.
Kidney transplantation offers best hope to women with end-stage renal disease who wish to become pregnant. Pregnancy in a kidney transplant recipient continues to remain challenging due to side effects of immunosuppressive medication, risk of deterioration of allograft function, risk of adverse maternal complications of preeclampsia and hypertension, and risk of adverse fetal outcomes of premature birth, low birth weight, and small for gestational age infants. The factors associated with poor pregnancy outcomes include presence of hypertension, serum creatinine greater than 1.
Women with chronic renal failure suffer from loss of libido, anovulatory vaginal bleeding or amenorrhea and high prolactin levels [ 1 ]. On dialysis most experience decreased libido and reduced ability to reach orgasm [ 2 — 4 ]. Conception is rare for women on dialysis.
A new study recently published in the American Journal of Transplantation reveals that the ability to successfully carry a pregnancy after kidney transplantation is very high, with Researchers led by Dorry Segev, MD, PhD, of Johns Hopkins University performed a systematic review and meta-analysis of articles published between and that reported pregnancy-related outcomes among KT recipients. Results found that a successful pregnancy is possible after receiving a kidney transplant, although the relatively high rate of medical complications of the pregnancy motivates very careful monitoring. Women who become pregnant after kidney transplantation have relatively high rates of pregnancy complications, such as preeclampsia, gestational diabetes, and preterm delivery. An accompanying editorial by V.
Kidney Transplant in pregnancy
Get free kidney-friendly recipe collections from DaVita dietitians. Find important updates here. Women with kidney disease who are on dialysis may wonder how dialysis will affect their chances of getting pregnant and delivering a healthy baby. Studies show that only 1 to 7 percent of women of childbearing age on dialysis can get pregnant. Over 90 percent of women of childbearing age on dialysis cannot get pregnant because having kidney disease can decrease the ability to produce healthy eggs that can be fertilized. Also, some women on dialysis may not menstruate or if they do, they have irregular periods.
Most women with chronic kidney disease or kidney failure who must go on dialysis -- more than 90 percent, by some accounts -- face a devastating reality: the loss of fertility. But it's not necessarily permanent, if a woman receives a transplant. For women fortunate enough to do so more than 90, people in the United States are on the kidney-transplant waiting list fertility is restored within a few months.
How living kidney donation can affect pregnancy
Fertility the ability to have a child tends to increase in both men and woman after a transplant. Are you thinking about pregnancy? If so, you should discuss it beforehand with your transplant team and other healthcare providers. There are many things to consider.
Kidney disease and pregnancy: It’s challenging, but possible