Solid organ transplantation in pregnancy

Wiles, Kate; Tillett, Alexandra L; Harding, Kate

doi:10.1111/tog.12263

Cited by 10 publications

(4 citation statements)

References 31 publications

(50 reference statements)

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“…18 Decreased levels are particularly associated with the second trimester and monitoring should reflect this. 19 Doses require uptitration, aiming for pre-pregnancy targets, 20 with a 2-3 times increase often required. 15 Free tacrolimus levels (not routinely measured), are increased in pregnancy.…”

Section: Graft Dysfunctionmentioning

confidence: 99%

Late pregnancy in women with renal transplants: A multidisciplinary guide

Mallett,

Scale,

Metodiev

et al. 2023

Obstet Med

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Kidney transplant recipients are at risk of complications in late pregnancy, with increased rates of pre-eclampsia, intrauterine growth restriction and preterm birth. It is recommended that these women receive more intensive monitoring after 20 weeks’ gestation, ideally provided by a multidisciplinary team in a tertiary centre. This review focuses on the management of late pregnancy in kidney transplant recipients, from the perspective of different members of the multidisciplinary team. This includes evidence and guidance to inform the nephrologist, obstetrician, obstetric anaesthetist, transplant surgeon, midwife, and a summary of the woman's perspective. The review outlines a late pregnancy and early postnatal care pathway as a common algorithm to be used by the whole multidisciplinary team.

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Section: Graft Dysfunctionmentioning

confidence: 99%

Late pregnancy in women with renal transplants: A multidisciplinary guide

Mallett,

Scale,

Metodiev

et al. 2023

Obstet Med

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“…Tacrolimus and azathioprine have consistently been shown to be safe to take during pregnancy, without increased risk of congenital abnormality. 123,124 Whereas some studies have identified SOT recipients taking azathioprine and tacrolimus to be associated with preterm delivery and low birth weight, 125 these risks are similar across all transplant patients, irrespective of which immunosuppressant is being taken. As such, it is more likely to be related to underlying maternal condition, not as a direct consequence to immunosuppression.…”

Section: Immunosuppression and Rejectionmentioning

confidence: 99%

Uterine Transplantation: Review of Livebirths and Reproductive Implications

et al. 2021

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Uterine transplantation (UTx) is a fertility restoring treatment for women with absolute uterine factor infertility. At a time when there is no question of the procedure's feasibility, and as the number of livebirths begins to increase exponentially, various important reproductive, fetal, and maternal medicine implications have emerged. Detailed outcomes from 17 livebirths following UTx are now available, which are reviewed herein, along with contextualized extrapolation from pregnancy outcomes in other solid organ transplants. Differences in recipient demographics and reproductive aspirations between UTx and other transplant recipients make extrapolating management strategies and outcomes in other solid organ transplants inappropriate. Whereas preterm delivery remains prominent, small for gestational age or hypertensive disorders do not appear to be as prevalent following UTx when compared to other solid organ transplants. Given the primary objective of undertaking UTx is to achieve a livebirth, publication of reproductive outcomes is essential at this early stage, to reflect on and optimize the management of future cases.

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“…Tacrolimus and azathioprine have consistently been shown as safe to administer during pregnancy, with no increased risk of congenital abnormality 67 . However, potentially teratogenic immunosuppression, such as MMF, should be stopped a minimum of 6 weeks prior to embryo transfer, and replaced by a different agent, such as azathioprine.…”

Section: Fertility Considerationsmentioning

confidence: 99%

“…Tacrolimus and azathioprine have consistently been shown as safe to administer during pregnancy, with no increased risk of congenital abnormality. 67 However, potentially teratogenic immunosuppression, such as MMF, should be stopped a minimum of 6 weeks prior to embryo transfer, and replaced by a different agent, such as azathioprine. In cases where MMF has not been used, the potential time between implantation and embryo transfer can be reduced further to 3 months, potentially reducing further cumulative immunosuppression exposure.…”

Section: Fertility Considerationsmentioning

confidence: 99%

Uterine Transplantation

Jones

Saso

Yazbek

et al. 2021

BJOG

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A uterine transplant, or womb transplant, provides a potential treatment for women who cannot become pregnant or carry a pregnancy because they do not have a womb, or have a womb that is unable to maintain a pregnancy. This is estimated to affect one in 500 women. Options for those who wish to start a family include adoption and surrogacy, but these are associated with legal, cultural, ethical and religious implications that may not be appropriate for some women and their families. A womb transplant is undertaken when the woman is ready to start a family, and is removed following the completion of their family.Womb transplants have been performed all over the world, with more than 70 procedures carried out so far. At least 23 babies have been born as a result, demonstrating that womb transplants can work. While the procedure offers a different option to adoption and surrogacy, it is associated with significant risks, including multiple major surgeries and the need to take medications that help to dampen the immune system to prevent rejection of the womb. To date there has been a 30% risk of a transplant being unsuccessful.Although the number of transplants to date is still relatively small, the number being performed globally is growing, providing an opportunity to learn from the experience gained so far. This paper looks at the issues that have been encountered, which may arise at each step of the process, and proposes a framework for the future. However, long term follow-up of cases will be essential to draw reliable conclusions about any overall benefits of this procedure.

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Solid organ transplantation in pregnancy

Cited by 10 publications

References 31 publications

Late pregnancy in women with renal transplants: A multidisciplinary guide

Late pregnancy in women with renal transplants: A multidisciplinary guide

Uterine Transplantation: Review of Livebirths and Reproductive Implications

Uterine Transplantation

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