Pregnancy care in solid organ transplant recipients

Kallapur, Aneesh; Jang, Christine; Yin, Ophelia; Mei, Jenny Y.; Afshar, Yalda

doi:10.1002/ijgo.13819

Cited by 12 publications

(4 citation statements)

References 74 publications

(166 reference statements)

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“…Following the transplantation and under immunosuppressive medications, the majority of our patients used progestin as the contraceptive method of choice. There is no evidence regarding the contraceptive method that should be used among SOT recipients [ 25 , 26 , 27 ], and previous surveys on effectiveness revealed various results [ 28 , 29 ]. Progestin may offer a safer method than progestin with estrogen, especially in this comorbid population (diabetes mellitus, unbalanced lipid profile) under immunosuppressant therapy.…”

Section: Discussionmentioning

confidence: 99%

Pregnancies and Gynecological Follow-Up after Solid Organ Transplantation: Experience of a Decade

Bedin

Carbonnel

Snanoudj

et al. 2022

JCM

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In recent years, solid organ transplantations, such as kidney or lung grafts, have been performed worldwide with an improvement of quality of life under immunosuppressive therapy and an increase in life expectancy, allowing young women to consider childbearing. In the current study, we conduct a retrospective study in two French centers for kidney and lung transplantations to evaluate the rate and outcomes of pregnancies, contraception and gynecological monitoring for women under 40 years old who underwent solid organ transplantation. Among 210 women, progestin was the most widely used contraceptive method. Of the 210 women, 24 (11.4%) conceived 33 pregnancies of which 25 (75.8%) were planned with an immunosuppressant therapy switch. Of the 33 pregnancies, 7 miscarried (21.2%) and 21 (63.7%) resulted in a live birth with a high rate of pre-eclampsia (50%). No graft rejections were observed during pregnancies. Among the deliveries, 19 were premature (90.5%, mostly due to induced delivery) and the C-section rate was high (52.4%). No particular pathology was identified among newborns. We conclude that pregnancies following solid organ transplantation are feasible, and while they are at an increased risk of pre-eclampsia and prematurity, they should still be permitted with close surveillance by a multidisciplinary care team.

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Section: Discussionmentioning

confidence: 99%

Pregnancies and Gynecological Follow-Up after Solid Organ Transplantation: Experience of a Decade

Bedin

Carbonnel

Snanoudj

et al. 2022

JCM

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“…It has been generally recommended that solid organ transplant recipients be screened for syphilis, hepatitis B and C, human immunodeficiency virus, rubella, varicella, herpes simplex virus, toxoplasmosis, and CMV and tuberculosis. 35 Our UTx programs did not universally screen for toxoplasmosis or herpes simplex virus. Ideally, appropriate vaccinations should be given before the UTx and appropriate nonlive vaccines before pregnancy.…”

Section: Infectious Considerationsmentioning

confidence: 99%

“…Therefore, increased surveillance and awareness of infectious diseases with special attention to viruses such as CMV, and now severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is needed. It has been generally recommended that solid organ transplant recipients be screened for syphilis, hepatitis B and C, human immunodeficiency virus, rubella, varicella, herpes simplex virus, toxoplasmosis, and CMV and tuberculosis 35. Our UTx programs did not universally screen for toxoplasmosis or herpes simplex virus.…”

Section: Introductionmentioning

confidence: 96%

Genetic Screening and Teratogenic Exposures: Considerations in Caring for the Uterus Transplant Patient

Wang

Perni

Gregg

2022

Clinical Obstetrics &Amp; Gynecology

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Counseling the uterus transplant patient requires an enhanced knowledge of unique genetic challenges that include an understanding of the spectrum of Mayer-Rokitansky-Küster-Hauser syndrome. Patients should understand their options for genetic screening and testing including preimplantation genetic testing for aneuploidy, genetic screening, and diagnostic testing. This patient population is potentially at risk for fetal anomalies due to the increased susceptibility to infections, such as cytomegalovirus. There are management strategies to minimize this risk. The risk of teratogenicity from mycophenolate is eliminated by a washout period before embryo transfer.

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“…Both in the case of liver and kidney transplantation, organ recipients comprise patients in various age groups, including people of childbearing age. For a long time, pregnancy in female transplant recipients was a controversial issue due to the lack of data on the safety of immunosuppressive drugs for the developing foetus [1][2][3].…”

Section: Introductionmentioning

confidence: 99%

Does Intrauterine Exposure of the Foetus to Immunosuppressive Drugs Used by the Mother—The Organ Recipient—Affect the Development of Post-Vaccination Immunity against Selected Viral Diseases in Children of These Mothers in Postnatal Life?

et al. 2023

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Background: Pregnancy in women who are organ recipients has long been a controversial issue due to the lack of data on the safety of immunosuppressive drugs for the developing foetus. Scientific data show that the effect of immunosuppressants on the foetus causes an impairment of T and B lymphocyte function and a reduction in their total number. For this reason, some authors recommend delaying the obligatory immunization of infants. The aim of the study is to analyse the impact of chronic immunosuppressive therapy used during pregnancy by women after organ transplantation on the effectiveness of anti-viral vaccinations in the children of these women. Methods: Concentrations of post-vaccination IgG antibodies (measles, HBV, polio) in 18 children of post-transplant mothers (9KTRs; 9LTRs) were determined using the ELISA method. The results were compared with the control group (n = 21). The incidence of vaccination AEs was also analysed. Results: There were no significant differences between the analysed groups in the concentrations of antibodies against HBV, measles and polio (p > 0.05). Conclusions: No difference was observed in the immunogenicity of HBV, polio and measles vaccinations between children of post-transplant mothers and the general population. The immunization of children of post-transplant mothers is safe, and the percentage of adverse post-vaccination events does not differ from the general population. The obtained study results do not indicate the necessity for modifying the vaccination program for HBV, measles, and polio in this group of patients.

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Pregnancy care in solid organ transplant recipients

Cited by 12 publications

References 74 publications

Pregnancies and Gynecological Follow-Up after Solid Organ Transplantation: Experience of a Decade

Pregnancies and Gynecological Follow-Up after Solid Organ Transplantation: Experience of a Decade

Genetic Screening and Teratogenic Exposures: Considerations in Caring for the Uterus Transplant Patient

Does Intrauterine Exposure of the Foetus to Immunosuppressive Drugs Used by the Mother—The Organ Recipient—Affect the Development of Post-Vaccination Immunity against Selected Viral Diseases in Children of These Mothers in Postnatal Life?

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