Reproduction and transplantation: report on the AST Consensus Conference on Reproductive Issues and Transplantation.
It has been almost 50 years since the first child was born to a female transplant recipient. Since that time pregnancy has become common after transplantation, but physicians have been left to rely on case reports, small series and data from voluntary registries to guide the care of their patients. Many uncertainties exist including the risks that pregnancy presents to the graft, the patient herself, and the long-term risks to the fetus. It is also unclear how to best modify immunosuppressive agents or treat rejection during pregnancy, especially in light of newer agents available where pregnancy safety has not been established. To begin to address uncertainties and define clinical practice guidelines for the transplant physician and obstetrical caregivers, a consensus conference was held in Bethesda, Md. The conferees summarized both what is known and important gaps in our knowledge. They also identified key areas of agreement, and posed a number of critical questions, the resolution of which is necessary in order to establish evidence-based guidelines. The manuscript summarizes the deliberations and conclusions of the conference as well as specific recommendations based on current knowledge in the field.
McKay
Dianne B
DB
Transplantation Medicine, The Scripps Clinic/Scripps Green Hospital, The Scripps Research Institute, La Jolla, California, USA. dmckay@scripps.edu
Josephson
Michelle A
MA
Armenti
Vincent T
VT
August
Phyllis
P
Coscia
Lisa A
LA
Davis
Connie L
CL
Davison
John M
JM
Easterling
Thomas
T
Friedman
Jan E
JE
Hou
Susan
S
Karlix
Janet
J
Lake
Kathleen D
KD
Lindheimer
Marshall
M
Matas
Arthur J
AJ
Moritz
Michael J
MJ
Riely
Caroline A
CA
Ross
Lainie Friedman
LF
Scott
James R
JR
Wagoner
Lynne E
LE
Wrenshall
Lucile
L
Adams
Patricia L
PL
Bumgardner
Ginny L
GL
Fine
Richard N
RN
Goral
Simin
S
Krams
Sheri M
SM
Martinez
Olivia M
OM
Tolkoff-Rubin
Nina
N
Pavlakis
Martha
M
Scantlebury
Velma
V
D005260:Female; D006801:Humans; D016377:Organ Transplantation; D011247:Pregnancy; D012098:Reproduction