title: Pregnancies in liver and kidney transplant recipients: a review of the current literature and recommendation.
abstract: In this article, we focus on the biggest groups of organ transplant recipients, patients with a kidney or liver graft. Among these patients, about one sixth included women of childbearing potential. Therefore, the wish of getting pregnant is frequent in these peculiar patients, and careful planning and management of the pregnancies requires the expertise of obstetricians, midwives and transplant experts. Altogether, the outcome of the pregnancies in these women is acceptable. About 75% off all pregnancies ended successfully with live births, and this is comparable if not superior to pregnancies in healthy women. This success might be caused not only by the special and intensive care provided to these high-risk pregnancies by the transplant centres but also by the low rate of unplanned pregnancies. The risk of rejections and organ loss after delivery is about 10%, and it is slightly enhanced in liver transplant recipients (LTRs) in comparison to kidney graft recipients (KTRs) but the number of organ losses in direct association with a pregnancy is rare. However, there is not only a higher frequency of pregnancy-associated disorders such as pre-eclampsia and preterm delivery but also an acceleration of hypertension, new-onset diabetes mellitus and newly arising infections also favoured by the maintained immunosuppressive therapy. This implies a specialized 'control system' for these pregnant women that comprises ultrasound and Doppler investigation for risk assessment, infection screening, suitable therapy and the choice of non-teratogenic immunosuppressives. Antihypertensive treatment must be well balanced and adjusted to the possible growth-retarding effect on the foetus as well as on the co-morbidity of the mother. Finally, supplementation of vitamin D and iron is much more important in these transplanted women than in healthy pregnant women as vitamin D deficiency and anaemia are discussed to have an impact on pre-eclampsia and preterm delivery. These claims are widely discussed. Furthermore, the current literature is systematically reviewed by Scopus analysis.
authors.affiliation: Leibniz University Hannover, Institute of Technical Chemistry, Hannover, Germany; Department of Nephrology, Hannover Medical School, Hannover, Germany. Electronic address: blume@iftc.uni-hannover.de.
authors.forename: C
authors.initials: C
authors.lastname: Blume
authors.affiliation: Outpatient Clinic for Liver Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Pischke
authors.affiliation: Department of Obstetrics, Gynaecology and Reproductive Medicine, Hannover Medical School, Hannover, Germany.
authors.forename: F
authors.initials: F
authors.lastname: von Versen-Höynck
authors.affiliation: Department of Obstetrics, Gynaecology and Reproductive Medicine, Hannover Medical School, Hannover, Germany.
authors.forename: H H
authors.initials: HH
authors.lastname: Günter
authors.affiliation: Midwifery Research and Education Unit, Department of Obstetrics, Gynaecology and Reproductive Medicine, Hannover Medical School, Hannover, Germany.
authors.forename: M M
authors.initials: MM
authors.lastname: Gross
mesh_terms: D050071:Bone Density Conservation Agents / Q000627:therapeutic use; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D007165:Immunosuppression Therapy / Q000009:adverse effects; D007501:Iron / Q000627:therapeutic use; D016030:Kidney Transplantation / Q000379:methods; D016031:Liver Transplantation / Q000379:methods; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D011248:Pregnancy Complications / Q000209:etiology / Q000517:prevention & control*; D011256:Pregnancy Outcome; D018570:Risk Assessment; D012307:Risk Factors; D014131:Trace Elements / Q000627:therapeutic use; D066027:Transplant Recipients; D014807:Vitamin D / Q000627:therapeutic use
chemical_list: D050071:Bone Density Conservation Agents; D014131:Trace Elements; D014807:Vitamin D; D007501:Iron
keywords: immunosuppression; kidney transplantation; liver transplantation; outcome; pregnancy