Reproductive health in Irish female renal transplant recipients

Kennedy, Claire; Hussein, Wael F.; Spencer, S.; Walshe, J.; Denton, Mark D.; Conlon, Peter J.; Magee, Colm

doi:10.1007/s11845-011-0767-4

Cited by 17 publications

(8 citation statements)

References 10 publications

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“…The literature is rich with reports on extreme situations, including kidney transplantation during pregnancy; while single cases cannot lead to potentially risky changes in daily practices, such cases do warn against fully negative attitudes and suggest an individually based decision [ 145 , 146 , 147 , 148 , 149 , 150 , 151 ].…”

Section: Kidney Transplantationmentioning

confidence: 99%

Pregnancy in Chronic Kidney Disease: Need for Higher Awareness. A Pragmatic Review Focused on What Could Be Improved in the Different CKD Stages and Phases

Piccoli

Zakharova

Attini

et al. 2018

JCM

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Pregnancy is possible in all phases of chronic kidney disease (CKD), but its management may be difficult and the outcomes are not the same as in the overall population. The prevalence of CKD in pregnancy is estimated at about 3%, as high as that of pre-eclampsia (PE), a better-acknowledged risk for adverse pregnancy outcomes. When CKD is known, pregnancy should be considered as high risk and followed accordingly; furthermore, since CKD is often asymptomatic, pregnant women should be screened for the presence of CKD, allowing better management of pregnancy, and timely treatment after pregnancy. The differential diagnosis between CKD and PE is sometimes difficult, but making it may be important for pregnancy management. Pregnancy is possible, even if at high risk for complications, including preterm delivery and intrauterine growth restriction, superimposed PE, and pregnancy-induced hypertension. Results in all phases are strictly dependent upon the socio-sanitary system and the availability of renal and obstetric care and, especially for preterm children, of intensive care units. Women on dialysis should be aware of the possibility of conceiving and having a successful pregnancy, and intensive dialysis (up to daily, long-hours dialysis) is the clinical choice allowing the best results. Such a choice may, however, need adaptation where access to dialysis is limited or distances are prohibitive. After kidney transplantation, pregnancies should be followed up with great attention, to minimize the risks for mother, child, and for the graft. A research agenda supporting international comparisons is highly needed to ameliorate or provide knowledge on specific kidney diseases and to develop context-adapted treatment strategies to improve pregnancy outcomes in CKD women.

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Section: Kidney Transplantationmentioning

confidence: 99%

Pregnancy in Chronic Kidney Disease: Need for Higher Awareness. A Pragmatic Review Focused on What Could Be Improved in the Different CKD Stages and Phases

Piccoli

Zakharova

Attini

et al. 2018

JCM

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“…The women received Tac, an antimetabolite, and prednisolone as immunosuppressive therapy. 36 In a regression analysis, Tac use in combination with MMF (compared with other treatment options) appeared to be a positive predictor of pregnancy within 1 year for female SOT recipients trying to conceive in addition to regular menstrual cycle and age. 34 Based on the above findings, despite limited data, it appears that Tac treatment is associated with a higher to normal infertility rate among female transplant recipients.…”

Section: Effects On Female Fertilitymentioning

confidence: 95%

Usage of Tacrolimus and Mycophenolic Acid During Conception, Pregnancy, and Lactation, and Its Implications for Therapeutic Drug Monitoring: A Systematic Critical Review

Le¹,

Francke

Andrews

et al. 2020

Therapeutic Drug Monitoring

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Background: Conception, pregnancy, and lactation following solid organ transplantation require appropriate management. The most frequently used immunosuppressive drug combination after solid organ transplantation consists of tacrolimus (Tac) plus mycophenolic acid (MPA). Here, the effects of Tac and MPA on fertility, pregnancy, and lactation are systematically reviewed, and their implications for therapeutic drug monitoring (TDM) are discussed. Methods: A systematic literature search was performed (August 19, 2019) using Ovid MEDLINE, EMBASE, the Cochrane Central Register of controlled trials, Google Scholar, and Web of Science, and 102 studies were included. Another 60 were included from the reference list of the published articles. Results: As MPA is teratogenic, women who are trying to conceive are strongly recommended to switch from MPA to azathioprine. MPA treatment in men during conception seems to have no adverse effect on pregnancy outcomes. Nevertheless, in 2015, the drug label was updated with additional risk minimization measures in a pregnancy prevention program. Data on MPA pharmacokinetics during pregnancy and lactation are limited. Tac treatment during conception, pregnancy, and lactation seems to be safe in terms of the health of the mother, (unborn) child, and allograft. However, Tac may increase the risk of hypertension, preeclampsia, preterm birth, and low birth weight. Infants will ingest very small amounts of Tac via breast milk from mothers treated with Tac. However, no adverse outcomes have been reported in children exposed to Tac during lactation. During pregnancy, changes in Tac pharmacokinetics result in increased unbound to whole-blood Tac concentration ratio. To maintain Tac concentrations within the target range, increased Tac dose and intensified TDM may be required. However, it is unclear if dose adjustments during pregnancy are necessary, considering the higher concentration of (active) unbound Tac. Conclusions: Tac treatment during conception, pregnancy and lactation seems to be relatively safe. Due to pharmacokinetic changes during pregnancy, a higher Tac dose might be indicated to maintain target concentrations. However, more evidence is needed to make recommendations on both Tac dose adjustments and alternative matrices than whole-blood for TDM of Tac during pregnancy. MPA treatment in men during conception seems to have no adverse effect on pregnancy outcomes, whereas MPA use in women during conception and pregnancy is strongly discouraged.

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“…To maintain consistency when extracting data, Deshpande [3] used the number of pregnancies as the denominator for the analysis of pregnancy outcomes. Three of the more recent studies included twin pregnancies [15,17,19], an issue that has not been mentioned by Deshpande [3,4]. For the analyses of obstetric complications and delivery outcomes, the number of live births plus stillbirths was used as the denominator.…”

Section: Care During Pregnancy Labour and Birthmentioning

confidence: 99%

“…However, the studies differ regarding the actual reference point. In Ireland [17] and Germany [7], the reference point was set at the time of conception, while Deshpande [3] referred to the maternal age at pregnancy. Altogether, the variability of maternal age appears to be of minor clinical relevance for the general outcome of the pregnancies.…”

Section: Care During Pregnancy Labour and Birthmentioning

confidence: 99%

Pregnancies in liver and kidney transplant recipients: a review of the current literature and recommendation

Blume

Pischke

Versen‐Höynck

et al. 2014

Best Practice & Research Clinical Obstetrics & Gynaecol

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Reproductive health in Irish female renal transplant recipients

Abstract: A significant proportion of women who attempt to conceive following renal transplantation are successful, without the use of assisted fertility. Pregnancy in this setting warrants meticulous multidisciplinary care.

Cited by 17 publications

References 10 publications

Pregnancy in Chronic Kidney Disease: Need for Higher Awareness. A Pragmatic Review Focused on What Could Be Improved in the Different CKD Stages and Phases

Pregnancy in Chronic Kidney Disease: Need for Higher Awareness. A Pragmatic Review Focused on What Could Be Improved in the Different CKD Stages and Phases

Usage of Tacrolimus and Mycophenolic Acid During Conception, Pregnancy, and Lactation, and Its Implications for Therapeutic Drug Monitoring: A Systematic Critical Review

Pregnancies in liver and kidney transplant recipients: a review of the current literature and recommendation

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