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Pregnancy and transplant

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#1 Pregnancy and transplant

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Pregnancy and transplant

To receive news and publication updates for International Journal of Nephrology, enter your email address in the box below. This is an open access article distributed Free hot black women getting banged the Creative Commons Attribution Licensewhich permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 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 Pregnancy and transplant. Sirolimus and mycophenolate mofetil should be stopped 6 weeks prior to conception. The optimal time to conception continues to remain an area of contention. It is important that counseling for childbearing should start as early as prior to getting a kidney transplant and should be done at every clinic visit after transplant. Breast-feeding is not contraindicated and should not be discouraged. This review will help the physicians in medical optimization and counseling of renal transplant recipients of childbearing age. The first successful pregnancy in kidney transplant recipient occurred in to year-old Edith Helm who received a kidney from her identical twin sister in and she delivered a healthy full-term boy of grams by cesarean section. Her twin sister, Wanda Foster, also gave birth four times successfully after donating the kidney [ 1 ]. Since then, there have been many successful pregnancies that have been reported in kidney transplant recipients offering hope to women who have always wished to conceive. Current knowledge of...

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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...

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Reproductive success is a common, expected outcome for male and female recipients of solid-organ transplants. Men can father children, and women can become pregnant and carry the fetus to delivery. There are, however, important maternal and fetal complications that need to be considered to provide optimal care to the mother and her infant. Although pregnancy is common after the transplantation of all solid organs, guidelines for optimal counseling and clinical management are limited. This review discusses information to help the physician counsel the kidney transplant recipient about risks of pregnancy for the mother and the fetus and provides information to help guide treatment of the pregnant transplant recipient. End-stage organ disease disrupts normal gonadal function; consequently, pregnancies in patients with end-stage disease are still relatively uncommon 1. Fertility is improved within months after the successful replacement of an infirmed organ 2 ; therefore, it is not surprising that increasing numbers of pregnancies are reported in patients with transplanted kidneys, liver, heart, lungs, and small bowel and even in those with multiple organ transplants. The numbers of pregnancies that have actually occurred in maternal or paternal transplant recipients have not been quantified. In an attempt to estimate numbers of pregnancies that have occurred in transplant recipients, Davison and Baylis 3 tabulated all pregnancies reported within the worldwide literature up to the year Reports of 14, pregnancies were acquired through review of case, center, and registry reports. Certainly this number is an underestimation, because reporting of all pregnancies in transplant recipients is no longer widespread practice. Several pregnancy registries exist and have published information on maternal, paternal, and infant outcomes. Three of these registries have reported the largest numbers to date and include in United States the National Transplantation Registry NTPR , a voluntary registry initiated in that relies on transplant...

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Successful pregnancy outcomes are possible among all solid organ transplant recipients. Patients should be fully counseled regarding the potential adverse fetal outcomes, including prematurity and low birth weight. Transplant recipients are at an increased risk for both maternal and neonatal complications and should be seen by a high-risk obstetrician in conjunction with their transplant teams. Ideally, preconception counseling begins during the pretransplantation evaluation process. Initiating contraception early after transplantation is ideal, and long-acting reversible methods such as intrauterine devices and subdermal implants may be preferred. Pregnancy should be avoided for at least 1 year after transplantation to limit the potential risks of early pregnancy that may adversely affect both allograft function and fetal well-being. Hypertension, diabetes, and infection should be monitored and treated to minimize fetal risks during pregnancy. Maintenance of current immunosuppression is usually recommended, with the exception of mycophenolic acid products, which when possible should be discontinued before conception and replaced with an alternative medication. Throughout pregnancy, immunosuppression must be maintained at appropriate dosing to avoid graft rejection. During labor and delivery, cesarean delivery should be performed for obstetric reasons only. A multidisciplinary team should manage pregnant transplant recipients before, during, and following pregnancy. Breastfeeding and long-term in utero exposure to immunosuppressants for offspring of transplant recipients continue to require further investigation but have been encouraged by recent reports. Continued reporting of post-transplantation pregnancy outcomes to the National Transplantation Pregnancy Registry is highly encouraged. In , 25, recipients received a solid organ transplant in the United States, including transplantation of the kidney, liver, pancreas, small bowel, heart, and lung. Obstetric considerations are therefore a pertinent part of the pretransplantation counseling process. For many women, the underlying disease may compromise fertility, and one of the benefits of transplantation is its restorative effect on ovulation and fertility. The first successful...

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Jan 11, Author: Several issues should be discussed with female potential transplant recipients and their partners, preferably prior to transplantation. Such issues include preconception counseling eg, fertility issues, vaccinations, contraceptive options and the timing of pregnancy. Types of organ transplants reported among female transplant recipients who subsequently conceived include the following, in descending order [ 2 , 3 , 4 ]:. Normal allograft ultrasonography results [ 5 , 6 ]. Although reports show a good success rate of pregnancy in liver transplant recipients, these pregnancies carry high risk to the patient, fetus, and allograft and need to be closely monitored in specialized centers by an integrated team that includes a transplant hepatologist, a transplant surgeon, an obstetrician experienced in high-risk pregnancies, and a perinatologist or neonatologist. Although planned pregnancy after liver transplantation is relatively common, acute liver failure during pregnancy is very uncommon, and acute liver failure requiring liver transplantation during early stages of pregnancy is rare. Complications in fertile, antepartum, and postpartum orthotopic liver transplant recipients include the following:. Pregnancy-induced hypertension [ 9 ] ; intrauterine infections, anemia, preeclampsia, cholestasis, pyelonephritis [ 9 , 8 ]. Owing to a low rate of successful fetal delivery in case reports of antepartum liver transplantation, many hepatologists may be hesitant to select orthotopic liver transplantation as the treatment of choice in pregnant women with end-stage liver disease. Aggressive management of hypertension: The drug of choice is methyldopa [ 5 ] ; second-line agents include clonidine and calcium channel alpha blockers [ 5 ] ; contraindicated drugs include angiotensin-converting enzyme inhibitors ACEIs and angiotensin receptor blockers ARBs [ 10 ]. Close monitoring of graft function; if rejection is suspected, consider biopsy [ 3 ]. Frequent evaluations, preferably every 2 weeks [ 5 ]. Antibiotic prophylaxis for all surgical procedures [ 2 ]. Increased...

Pregnancy and transplant

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May 1, - Fertility is usually restored in women with renal transplants. Pregnancy is then common, occurring in 12% of women at childbearing age in one series [6]. Pregnancy success rate exceeds 90% after the first trimester.‎Introduction · ‎Effect of pregnancy on graft · ‎Immunosuppressive drugs. This review discusses information to help the physician counsel the kidney transplant recipient about risks of pregnancy for the mother and the fetus and  ‎Abstract · ‎Prevalence of Pregnancy in · ‎Fertility, Contraception, and. Successful pregnancy outcomes are possible among all solid organ transplant recipients. Patients should be fully counseled regarding the potential adverse.

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