[Post-renal transplant pregnancy: a project to plan carefully].
Kidney transplant is the best treatment for end-stage renal disease (ESRD) as it improves the quality of         life and reduces the mortality risk for most patients compared with maintenance dialysis. Additionally, evidence         from the literature suggests that renal function, endocrine status and libido rapidly improve after kidney transplant,         and one in 50 women of childbearing age become pregnant. Therefore, it seems clear that pregnancy after transplant         is a great challenge for physicians involved in this field. The available information on pregnancy outcomes is         largely derived from case reports and single-center series, which are unlikely to be representative. Moreover,         poor results are less likely to be reported. Many of the reports on long-term outcome show the results of past medical,         obstetric, and neonatal care, which may be very different from current practice. Attempts are being made to provide         more up-to-date, representative data through national transplantation pregnancy registries. A great number of         researchers worldwide have analyzed the biological and endocrinological machinery associated with this event.         Additionally, several strategies have been introduced to avoid unplanned pregnancies and to minimize maternal         and fetal complications in renal transplant recipients. It seems evident that the return to fertility soon after         transplant is often associated with unplanned pregnancy, which can expose both mother and fetus to considerable risks.         This underpins the necessity to recommend contraceptive counseling and start clinical follow-up in order to early         identify possible pregnancy-related risk factors. In general, pregnancy should not be recommended within the first         year after kidney transplant because the risk of acute rejection is greatest and immunosuppressive therapy the most         aggressive. It should be planned when organ function and immunosuppressive therapy are stabilized and there is no sign         of rejection, hypertension, or chronic infection. Additionally, renal transplant patients and their physicians together         must try to identify the best timing, carry out pre-pregnancy screening, and delineate clinical follow-up and future         pharmacological programs to minimize or avoid serious maternal and fetal complications. Finally, additional studies         are needed to better understand the physiology associated with this condition, improve the pharmacological approach,         and analyze the complex ethical and social implications of this important aspect of renal transplantation.
Sezione di Nefrologia, Dipartimento di Medicina, Universita' di Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy.
Alessandra
A
Trubian
Gianluca
G
Zaza
Carlo
C
Rugiu
Paola
P
Tomei
Antonio
A
Lupo
D003267:Contraception / Q000379:methods; D005260:Female; D006084:Graft Rejection / Q000517:prevention & control; D006801:Humans; D007165:Immunosuppression Therapy / Q000009:adverse effects; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000009:adverse effects; D007231:Infant, Newborn; D007676:Kidney Failure, Chronic / Q000601:surgery*; D016030:Kidney Transplantation / Q000502:physiology; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D011248:Pregnancy Complications / Q000517:prevention & control; D049168:Pregnancy, Unplanned; D013997:Time Factors
D007166:Immunosuppressive Agents