Multiple pregnancies in women after renal transplantation

Furman, Boris; Wiznitzer, Arnon; Hackmon, Rinat; Gohar, Josef; Mazor, Moshe

doi:10.1016/s0301-2115(98)00258-9

Cited by 33 publications

(22 citation statements)

References 13 publications

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“…Case reports are the only sources of information. 50,51 Few cases of triplet pregnancy have been reported with fair outcomes. [52][53][54][55] Our case may shed some light on triplet pregnancy outcomes.…”

Section: Kidney Transplant and Pregnancymentioning

confidence: 99%

Untitled

Mahmoud

Mujaibel²,

Attia³

et al. 2017

Exp Clin Transplant

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Triplet and higher-order multiple pregnancies can carry increased fetal and maternal complications. Reports of triplet pregnancies after kidney transplant are scarce and have been associated with perinatal complications. Presence of diabetes in such cases worsens both fetal and maternal outcomes. Here, we present a triplet pregnancy in a kidney transplant recipient with diabetes. We also reviewed the literature for causes, prevalence, and outcomes in association with chronic kidney disease, kidney transplant, and diabetes mellitus. The patient, a 31-year-female who received a living-donor kidney transplant, had a firsttime pregnancy 6 years after transplant. Pregnancy was complicated by gestational diabetes, preeclampsia, and miscarriage. She continued to have postpartumimpaired glucose tolerance. She became pregnant again after 6 months but required insulin therapy during her third trimester. Pregnancy was terminated by cesarean section for a viable small boy. Two years later, she had triplet pregnancy after ovulation induction with clomiphene. Glycemic control was maintained using intensive insulin therapy guided by frequent home blood glucose monitoring (HbA1c was 5.8% at 22 wk). Both gynecologic care and nephrologic care were carried out through outpatient follow-up. Pregnancy was complicated by hypertension and mild renal dysfunction without proteinuria and ended in elective premature cesarean section at 32 weeks of gestation. She had 3 male babies with low birth weights (1320, 1380, 1275 g), with the largest baby developing sepsis and requiring an intensive care unit stay and then incubator for 49 days. The other 2 required incubators for 36 days. Their weights after 22 months were 9, 16, and 11 kg. The mother is now normotensive with normal renal function and impaired glucose tolerance. Care of diabetic kidney recipients with triplet pregnancy constitutes a special challenge requiring a multispecialty skilled team to ensure the best outcome.

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Section: Kidney Transplant and Pregnancymentioning

confidence: 99%

Untitled

Mahmoud

Mujaibel²,

Attia³

et al. 2017

Exp Clin Transplant

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“…Tabela 1 -Utilização com sucesso de técnicas de PMA em mulheres transplantadas (casos publicados) [3][4][5][6][7][8][9][10][11][12] 2. Doente do sexo feminino de 33 anos, com infertilidade primária (por factor masculino), polineuropatia amiloidótica familiar (PAF), transplantada hepática há três anos (com boa função do enxerto), em imunossupressão com tacrolimus 5 mg/dia.…”

Section: Caso Clínicounclassified

“…Existem 18 casos publicados de utilização, com sucesso, de técnicas de procriação medicamente assistida (PMA) em mulheres transplantadas: 15 renais, duas hepá-ticas e uma reno-pancreática (Tabela 1). [3][4][5][6][7][8][9][10][11][12] CASOS CLÍNICOS (Tabela 2)…”

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Procriação Assistida em Mulheres Transplantadas: Experiência de uma Unidade de Medicina da Reprodução e Revisão da Literatura

et al. 2016

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73 RESUMODoenças em estádio terminal cursam tipicamente com distúrbios do eixo hipotálamo-hipófise-ovário, com consequente anovulação e infertilidade. A transplantação de órgãos sólidos aumentou a sobrevida e melhorou a capacidade reprodutiva das mulheres com este tipo de patologia. Embora a adopção seja uma possibilidade, a mulher transplantada infértil tem direito à sua autodeterminação reprodutiva com recurso a técnicas de procriação medicamente assistida. As gravidezes em mulheres transplantadas são de alto risco, mas não parece existir evidência de diferenças no desfecho obstétrico e neonatal nas grávidas transplantadas sujeitas a procriação assistida, comparativamente a gravidezes espontâneas. A utilização de técnicas de procriação assistida em mulheres transplantadas constitui um desafio médico, ético e psicossocial, cuja abordagem deve ser multidisciplinar, para assegurar o sucesso reprodutivo sem comprometer a função do órgão transplantado ou a saúde materna, permitindo o nascimento de uma criança saudável. A literatura existente mantém-se escassa. São apresentados três casos clínicos. The solid organ transplantation increased survival of patients with end-stage organs disease and the vast majority of women improve their reproductive capacity after transplantation. Although adoption can always be a possibility, the transplanted infertile woman has the right to self-reproductive determination using assisted reproductive techniques. While it is known that pregnancies in transplanted women are at high risk, there is no evidence of differences in pregnancy outcome in pregnant transplanted subject to technical, compared with spontaneous pregnancies. The use of assisted reproductive techniques in transplanted women is a medical, ethical and psychosocial challenge, whose approach must be multidisciplinary, to ensure reproductive success without compromising the function of the transplanted organ or maternal health, allowing the birth of a healthy child. The literature remains scarce. Three clinical cases are presented. Keywords: Fertility; Organ Transplantation; Pregnancy; Pregnancy Outcome; Reproductive Techniques, Assisted. CASO CLÍNICO INTRODUÇÃOAs insuficiências renal e hepática estão associadas a distúrbios no eixo hipotálamo-hipófise-ovário que levam ao comprometimento da função reprodutiva.1 Mesmo após o transplante, estima-se que aproximadamente 10-50% das mulheres sejam inférteis. 1As transplantações cardíaca e pulmonar são raras, sendo a maioria dos dados sobre a saúde reprodutiva extrapolados da transplantação renal.

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“…Her renal function was stable throughout pregnancy. Furman et al reported another twin pregnancy in a NTX patient after IVF with a stable renal function and cesarean delivery in 33 weeks gestation subsequent to the development of therapyresistant pregnancy-induced hypertension (PIH) [4]. Also in 2005, Khalaf et al reported on a NTX patient with renal obstruction, presumably due to enlarged ovaries after controlled ovarian hyperstimulation.…”

Section: Case Reportmentioning

confidence: 99%

“…In 1995, Lockwood et al performed the first successful IVF attempt in a NTX patient [3]. Subsequently, four reports of IVF in NTX patients have been reported, as presented in Table 1 [4][5][6][7] (PUBMED literature search on July 5, 2010; search terms: kidney transplant, renal allograft, in vitro fertilization, IVF, assisted reproduction, ART, pregnancy). To our best knowledge, the present case is the fifth reported successful pregnancy after IVF in a NTX patient and the first using single embryo transfer (SET).…”

Section: Introductionmentioning

confidence: 99%

Live birth after in vitro fertilization and single embryo transfer in a kidney transplant patient: a case report and review of the literature

Nouri

Bader

Helmy

et al. 2010

J Assist Reprod Genet

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Background To present a successful case of in vitro fertilization (IVF) and single embryo transfer (SET) in a kidney transplant (NTX) patient and review of the literature. Methods Case report and review of the literature. Setting IVF-Unit in a university medical center. Patient(s) A 31 year-old nulliparous woman with primary infertility and a history of two kidney transplants. Intervention(s) IVF-SET Main outcome measure(s) Live birth, renal transplant function. Results(s) IVF-SET resulted in a pregnancy with labor induction and cesarean delivery in the 37th week of gestation due to rising serum creatinine. There was no significant maternal or fetal morbidity.Conclusion(s) Successful IVF-SET is possible in NTX patients. To date, including this case, five cases of IVF in NTX patients have been reported in the literature without an apparently increased renal morbidity.

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Multiple pregnancies in women after renal transplantation

Cited by 33 publications

References 13 publications

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Procriação Assistida em Mulheres Transplantadas: Experiência de uma Unidade de Medicina da Reprodução e Revisão da Literatura

Live birth after in vitro fertilization and single embryo transfer in a kidney transplant patient: a case report and review of the literature

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