Clinical data come from cohorts of transplant recipients, but also from women with systemic lupus erythematosus or inflammatory intestinal diseases
July 6, 2022
Clinical data come from cohorts of transplant recipients, but also from women with systemic lupus erythematosus or inflammatory intestinal diseases. will describe the available data on the consequences of exposure to immunosuppressive drugs before and after birth (i.e. in childhood and young adult life). EPIDEMIOLOGICAL DATA Analysis of several national and international registries allows description of the epidemiology of pregnancies in women with a kidney transplant. The first article was published in 1992 . More recently, the results of the UK , Australian/New Zealander  and American  registries have been published. Finally, a meta-analysis that included 50 studies (2000C10) analysed the features of 4706 pregnancies after kidney transplantation . According to this meta-analysis, 73C79% (up to 91% in the UK registry) of pregnancies after kidney transplant will lead to a live birth [1, 10, 12], compared with 66.7% in Topotecan HCl (Hycamtin) the American general population . Moreover, spontaneous miscarriage, medical termination and stillbirth will occur in 12C14, 6C8 and 2.5C3% of pregnancies, respectively. The complication rate seems comparable to that of non-transplanted patients with CKD and similar levels of kidney function p85-ALPHA impairment . Epidemiological data are also available on pregnancies after transplantation of another organ, although they are less frequent. In women with a liver transplant, the findings of the American  and UK  registries as well as those of an important caseCcontrol study  were used to collect information on 650 births and to establish specific recommendations . Topotecan HCl (Hycamtin) After heart and lung transplantation, pregnancy remains exceptional. The most important series comes from the American registry with 37 births . Although data are limited, the rate of maternal and foetal complications seems higher than that after transplantation of other organs. Pregnant transplant-recipient women are at high risk of complications not only because of the graft and chronic treatment with immunosuppressive drugs, but also because of their age and/or concomitant pathologies (e.g. diabetes, hypertension, renal disease, renal malformations) . FOETAL COMPLICATIONS OF PREGNANCY IN KIDNEY TRANSPLANT RECIPIENTS Like for maternal complications, foetal complications are difficult to assess because besides the direct consequences of exposure to immunosuppressive drugs, many confounding factors, such as maternal age, concomitant pathologies (e.g. diabetes, hypertension, genetic disease, renal malformations), can influence the foetal outcome. The most frequent complication is preterm delivery, which has several possible aetiologies. About half of pregnant women with a kidney transplant will deliver before 37?weeks of gestation, compared with 12% in the general population . Among them, one-fifth women will deliver before 32?weeks of gestation . The mean gestational age is 36?weeks. Often, preterm delivery is induced and labour is triggered due to a maternal medical condition (hypertension, preeclampsia, kidney function deterioration) or a foetal problem (intrauterine growth restriction, foetal heart rhythm abnormalities, foetal abnormalities detected by Doppler ultrasonography). About 20% of babies present intrauterine growth restriction . Topotecan HCl (Hycamtin) The mean birthweight Topotecan HCl (Hycamtin) is 2400?g for babies of a transplant mother compared with 3300 in the general population . This is a predictable consequence of preterm delivery, but might also be influenced by other factors linked to organ transplantation, exposure to immunosuppressive drugs and/or maternal hypertension. Concerning congenital anomalies, study populations are often too small to offer enough statistical power. Nevertheless, except for genetic kidney diseases, such as autosomal dominant polycystic kidney disease or congenital abnormalities of the urinary tract , pregnancies in transplant recipients treated with azathioprine, corticosteroids or calcineurin inhibitors do not seems to be associated with a major increase of the risk of congenital anomalies in newborns [4, 16, 17]. In a prospective cohort, the rate of congenital anomalies in the foetus was 5% in transplant recipients and 2% in the general population. This difference was not significant . Sporadically, congenital kidney defects have been reported, for instance kidney agenesis in a 26-week foetus that died few hours after delivery and was exposed to prednisone, cyclosporine and azathioprine , or multicystic dysplastic kidney after maternal treatment with tacrolimus . IMMUNOSUPPRESSIVE THERAPY DURING PREGNANCY During and just before pregnancy, immunosuppression management is a challenge for the transplant specialist who must try to control the risk of graft rejection, preserve the anti-infection immunity to limit the occurrence of maternalCfoetal infections, and also protect the foetus from the toxicity and teratogenicity of the used drugs. As the immunosuppressive therapy cannot.