Izguerra-Ochoa LE, Renato-Parra M, Morales-Buenrostro LE

Language: Spanish
References: 57
Page: 20-29
PDF size: 347.31 Kb.

ABSTRACT

As in the rest of the world, in Mexico the population with chronic kidney disease (CKD) and kidney transplantation is increasingly growing. CKD affects fertility, but it can be recovered quickly after transplantation in most cases in individuals of childbearing age. Pregnancy involves both anatomical and functional changes to the kidneys and represents a risk for sensitization, even though no increase in events of rejection or graft loss has been demonstrated. Pregnancy in kidney transplant recipients increases obstetrical complications such as preeclampsia, gestational diabetes, preterm birth and low birth weight. Nephrologist, with the support of reproductive medicine physician, should propose a birth control method during the first year to determine if conditions are optimal, and the ideal moment for pregnancy. In addition, they should establish measures to minimize maternal and fetal complications. As the main objective of kidney transplant is to integrate individuals into functional life, it is important to address the kidney-transplant recipients’ fertility. However, pregnancy in the context of transplantation is subject to an increased risk of developing both maternal and fetal complications; risks that the patient and her partner should assume. Nephrologist plays a decisive role in providing information to the couple and in taking measures to reduce maternal and fetal risks. In kidney donor, it seems clear that there is increased risk of hypertensive disorders of pregnancy with no contraindication to donate. It is responsibility of the nephrologist to inform of these risks prior to donation.

REFERENCES

1. Murray JE, Reid DE, Harrison JH, Merrill JP. Successful pregnancies after human renal transplantation. N Engl J Med. 1963; 269 (7): 341-343.

2. Collins AJ, Foley RN, Chavers B et al. US Renal Data System 2013 Annual Data Report. Am J Kidney Dis. 2014; 63 (1 Suppl): A7.

3. Méndez-Durán A, Méndez-Bueno JF, Tapia-Yáñez T, Muñoz-Montes A, Aguilar-Sánchez L. Epidemiología de la insuficiencia renal crónica en México. Dial Traspl. 2010; 31 (1): 7-11.

4. Deshpande NA, James NT, Kucirka LM et al. Pregnancy outcomes in kidney transplant recipients: a systematic review and meta-analysis. Am J Transplant. 2011; 11 (11): 2388-2404.

5. Yildirim Y, Uslu A. Pregnancy in patients with previous successful renal transplantation. Int J Gynaecol Obstet. 2005; 90 (3): 198-202.

6. Anantharaman P, Schmidt RJ. Sexual function in chronic kidney disease. Adv Chronic Kidney Dis. 2007; 14 (2): 119-125.

7. Navaneethan SD, Vecchio M, Johnson DW et al. Prevalence and correlates of self-reported sexual dysfunction in CKD: a meta-analysis of observational studies. Am J Kidney Dis. 2010; 56 (4): 670-685.

8. Pertuz W, Castaneda DA, Rincon O, Lozano E. Sexual dysfunction in patients with chronic renal disease: does it improve with renal transplantation? Transplant Proc. 2014; 46 (9): 3021-3026.

9. Pezeshki M, Taherian AA, Gharavy M, Ledger WL. Menstrual characteristics and pregnancy in women after renal transplantation. Int J Gynaecol Obstet. 2004; 85 (2): 119-125.

10. Chakhtoura Z, Meunier M, Caby J et al. Gynecologic follow up of 129 women on dialysis and after kidney transplantation: a retros­pective cohort study. Eur J Obstet Gynecol Reprod Biol. 2015; 187: 1-5.

11. Delesalle AS, Robin G, Provôt F et al. Impact of end-stage renal disease and kidney transplantation on the reproductive system. Gynecol Obstet Fertil. 2015; 43 (1): 33-40.

12. Rafie S, Lai S, Garcia JE, Mody SK. Contraceptive use in female recipients of a solid-organ transplant. Prog Transplant. 2014; 24 (4): 344-348.

13. Xu L, Yang Y, Shi JG et al. Unwanted pregnancy among Chinese renal transplant recipients. Eur J Contracept Reprod Health Care. 2011; 16 (4): 270-276.

14. Kidney Disease: Improving Global Outcomes (KDIGO) Transplant Work Group. KDIGO clinical practice guideline for the care of kidney transplant recipients. Am J Transplant. 2009; 9 (Suppl 3): S1-155.

15. Stringer EM, Kaseba C, Levy J et al. A randomized trial of the intrauterine contraceptive device vs hormonal contraception in women who are infected with the human immunodeficiency virus. Am J Obstet Gynecol 2007; 197 (2): 144.e1-8.

16. Morrison CS, Sekadde-Kigondu C, Sinei SK, Weiner DH, Kwok C, Kokonya D. Is the intrauterine device appropriate contraception for HIV-1-infected women? BJOG. 2001; 108 (8): 784-790.

17. Krajewski CM, Geetha D, Gomez-Lobo V. Contraceptive options for women with a history of solid-organ transplantation. Transplantation. 2013; 95 (10): 1183-1186.

18. Prakash J. The kidney in pregnancy: A journey of three decades. Indian J Nephrol. 2012; 22 (3): 159-167.

19. Davison JM. The kidney in pregnancy: a review. J R Soc Med. 1983; 76 (6): 485-501.

20. Hou S. Pregnancy in renal transplant recipients. Adv Chronic Kidney Dis. 2013; 20 (3): 253-259.

21. McKay DB1, 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): 1592-1599.

22. Miniero R, Tardivo I, Curtoni ES et al. Pregnancy after renal transplantation in Italian patients: focus on fetal outcome. J Nephrol. 2002; 15 (6): 626-632.

23. Hebert MF, Zheng S, Hays K et al. Interpreting tacrolimus concentrations during pregnancy and postpartum. Transplantation. 2013; 95 (7): 908-915.

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

25. Beitins IZ, Bayard F, Ances IG, Kowarski A, Migeon CJ. The transplacental passage of prednisone and prednisolone in pregnancy near term. J Pediatr. 1972; 81 (5): 936-945.

26. Anderson GG, Rotchell Y, Kaiser DG. Placental transfer of methylprednisolone following maternal intravenous administration. Am J Obstet Gynecol. 1981; 140 (6): 699-701.

27. Blanford AT, Murphy BE. In vitro metabolism of prednisolone, dexamethasone, betamethasone, and cortisol by the human placenta. Am J Obstet Gynecol. 1977; 127 (3): 264-267.

28. Josephson MA, McKay DB. Pregnancy in the renal transplant recipient. Obstet Gynecol Clin North Am. 2010; 37 (2): 211-222.

29. Goldstein LH, Dolinsky G, Greenberg R et al. Pregnancy outcome of women exposed to azathioprine during pregnancy. Birth Defects Res A Clin Mol Teratol. 2007; 79 (10): 696-701.

30. Sifontis NM, Coscia LA, Constantinescu S, Lavelanet AF, Moritz MJ, Armenti VT. Pregnancy outcomes in solid organ transplant recipients with exposure to mycophenolate mofetil or sirolimus. Transplantation. 2006; 82 (12): 1698-1702.

31. Merlob P, Stahl B, Klinger G. Tetrada of the possible mycophenolate mofetil embryopathy: a review. Reprod Toxicol. 2009; 28 (1): 105-108.

32. Pérgola PE, Kancharla A, Riley DJ. Kidney transplantation during the first trimester of pregnancy: immunosuppression with mycophenolate mofetil, tacrolimus, and prednisone. Transplantation. 2001; 71 (7): 994-997.

33. Jankowska I, Oldakowska-Jedynak U, Jabiry-Zieniewicz Z, et al. Absence of teratogenicity of sirolimus used during early pregnancy in a liver transplant recipient. Transplant Proc. 2004; 36 (10): 3232-3233.

34. Chu SH, Liu KL, Chiang YJ, Wang HH, Lai PC. Sirolimus used during pregnancy in a living related renal transplant recipient: a case report. Transplant Proc. 2008; 40 (7): 2446-2448.

35. Framarino dei Malatesta M, Corona LE, De Luca L et al. Successful pregnancy in a living-related kidney transplant recipient who received sirolimus throughout the whole gestation. Transplantation. 2011; 91 (9): e69-71.

36. Perales-Puchalt A, Vila Vives JM, López Montes J, Diago Almela VJ, Perales A. Pregnancy outcomes after kidney transplantation-immunosuppressive therapy comparison. J Matern Fetal Neonatal Med. 2012; 25 (8): 1363-1366.

37. Moretti ME, Sgro M, Johnson DW et al. Cyclosporine excretion into breast milk. Transplantation. 2003; 75 (12): 2144-2146.

38. Sahay M. Pregnancy in chronic kidney disease. Indian J Nephrol. 2015; 25 (4): 199-200.

39. Armenti VT, Radomski JS, Moritz MJ et al. Report from the National Transplantation Pregnancy Registry (NTPR): outcomes of pregnancy after transplantation. Clin Transpl. 2004: 103-114.

40. Coscia LA, Constantinescu S, Moritz MJ et al. Report from the National Transplantation Pregnancy Registry (NTPR): outcomes of pregnancy after transplantation. Clin Transpl. 2008; 89-105.

41. Aivazoglou L, Sass N, Silva HT Jr, Sato JL, Medina-Pestana JO, De Oliveira LG. Pregnancy after renal transplantation: an evaluation of the graft function. Eur J Obstet Gynecol Reprod Biol. 2011; 155 (2): 129-131.

42. Hebral AL, Cointault O, Connan L et al. Pregnancy after kidney transplantation: outcome and anti-human leucocyte antigen alloimmunization risk. Nephrol Dial Transplant. 2014; 29 (9): 1786-1793.

43. American College of Obstetricians and Gynecologists. ACOG Practice Bulletin No. 95: anemia in pregnancy. Obstet Gynecol. 2008; 112 (1): 201-207.

44. Magee LA, von Dadelszen P, Darley J, Beguin Y. Erythropoiesis and renal transplant pregnancy. Clin Transplant. 2000; 14 (2): 127-135.

45. Concepcion BP, Schaefer HM. Caring for the pregnant kidney transplant recipient. Clin Transplant. 2011; 25 (6): 821-829.

46. Pinheiro HS, Mituiassu AM, Carminatti M, Braga AM, Bastos MG. Urinary tract infection caused by extended-spectrum beta-lactamase-producing bacteria in kidney transplant patients. Transplant Proc. 2010; 42 (2): 486-487.

47. McKay DB, Josephson MA. Pregnancy after kidney transplantation. Clin J Am Soc Nephrol. 2008; 3 (Suppl 2): S117-S125.

48. Henderson JT, Whitlock EP, O’Connor E, Senger CA, Thompson JH, Rowland MG. Low-dose aspirin for prevention of morbidity and mortality from preeclampsia: a systematic evidence review for the U.S. Preventive Services Task Force. Ann Intern Med. 2014; 160 (10): 695-703.

49. Roberge S, Villa P, Nicolaides K et al. Early administration of low-dose aspirin for the prevention of preterm and term preeclampsia: a systematic review and meta-analysis. Fetal Diagn Ther. 2012; 31 (3): 141-146.

50. Bramham K, Soh MC, Nelson-Piercy C. Pregnancy and renal outcomes in lupus nephritis: an update and guide to management. Lupus. 2012; 21 (12): 1271-1283.

51. Sáez N, Carvajal J. Tamizaje y prevención de pre-eclampsia guiado por Doppler de arterias uterinas: revisión sistemática de la literatura. Rev Chil Obstet Ginecol. 2012; 77 (3): 235-242.

52. Ethics Committee of the Transplantation Society. The consensus statement of the Amsterdam Forum on the Care of the Live Kidney Donor. Transplantation. 2004; 78 (4): 491-492.

53. Ibrahim HN, Akkina SK, Leister E et al. Pregnancy outcomes after kidney donation. Am J Transplant. 2009; 9 (4): 825-834.

54. Ahmadi AR, Lafranca JA, Claessens LA et al. Shifting paradigms in eligibility criteria for live kidney donation: a systematic review. Kidney Int. 2015; 87 (1): 31-45.

55. Garg AX, Nevis IF, McArthur E et al. Gestational hypertension and preeclampsia in living kidney donors. N Engl J Med. 2015; 372 (2): 124-133.

56. LaPointe Rudow D, Hays R, Baliga P et al. Consensus confe­rence on best practices in live kidney donation: recommendations to optimize education, access, and care. Am J Transplant 2015; 15(4): 914-922.

57. Morken NH, Diaz-Garcia C, Reisaeter AV et al. Obstetric and neonatal outcome of pregnancies fathered by males on immunosuppression after solid organ transplantation. Am J Transplant. 2015; 15 (6): 1666-1673.