Jain Ashokkumar B, Reyes J, Marcos Amadeo, Mazariegos G, Eghtesad Bijan, Fontes Paulo A, Cacciarelli Thomas V, Marsh J Wallis, de Vera Michael E, Rafail Ann, Starzl Thomas E, Fung John J
Thomas E. Starzl Transplantation Institute, Division of Transplantation, Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
Transplantation. 2003 Sep 15;76(5):827-32. doi: 10.1097/01.TP.0000084823.89528.89.
Chronic liver disease often leads to amenorrhea in women of childbearing age. There are several reports of successful pregnancy after liver transplantation (LTx) with cyclosporine A immunosuppression. Tacrolimus has been increasingly used in solid-organ transplantation, and the effect of the drug on pregnancy is still of interest to clinicians. This study updates our single-center experience.
All pregnancies after LTx with tacrolimus immunosuppression were followed prospectively. Patients' clinical courses during pregnancy and labor along with gestational period and birth weight were catalogued. Changes in liver function, renal function, and immunosuppression also were recorded. The birth weight percentile was calculated on the basis of the gestational period using a standard chart.
Thirty-seven mothers delivered 49 babies. Three mothers delivered three times, and six mothers delivered two times. Thirty-six mothers (97%) survived the pregnancy, and 36 allografts (97%) survived. The one death and graft loss was in a patient who demonstrated infra-aortic arterial graft, which clotted by the gravid uterus during labor. The patient developed a gangrenous liver and died before she could undergo retransplantation. The mean gestational period was 36.4+/-3.2 weeks, excluding two premature deliveries at 23 and 24 weeks gestation. Twenty-two babies (46.9%) were delivered by cesarean section, and the other babies were delivered vaginally. In addition to the two premature babies, one baby, who was born to a mother with Alagille syndrome, died from congenital birth defects. The rest of the newborns survived. The mean birth weight was 2,797+/-775 g, with 38 babies (78%) weighing more than 2,000 g. The mean birth weight percentile to gestational period was 54+/-23. Four babies (8.5%) had a birth weight percentile of less than 25, and 28 babies (59.6%) had a birth weight percentile greater than 50. Twelve patients demonstrated an increase in hepatic enzymes without jaundice during the pregnancy. All of them responded to augmentation of immunosuppression.
The present report reconfirms the safety of tacrolimus during pregnancy after LTx. Preterm delivery and low birth weight seem to be a persistent problem in all solid-organ transplantation under any form of immunosuppression. However, toxemia of pregnancy and new onset of hypertension seem to be have a low occurrence with the use of tacrolimus.
慢性肝病常导致育龄期女性闭经。有几篇关于接受环孢素A免疫抑制的肝移植（LTx）后成功妊娠的报道。他克莫司已越来越多地用于实体器官移植，该药对妊娠的影响仍是临床医生关注的焦点。本研究更新了我们单中心的经验。
对所有接受他克莫司免疫抑制的肝移植术后妊娠进行前瞻性随访。记录患者孕期和分娩期间的临床过程以及妊娠期和出生体重。还记录了肝功能、肾功能和免疫抑制的变化。根据妊娠期使用标准图表计算出生体重百分位数。
37位母亲分娩了49名婴儿。3位母亲分娩3次，6位母亲分娩2次。36位母亲（97%）妊娠存活，36个移植肝（97%）存活。1例死亡和移植肝失功发生在1例接受主动脉下动脉移植的患者，其移植血管在分娩时被妊娠子宫压迫导致血栓形成。该患者发生坏疽性肝并在再次移植前死亡。平均妊娠期为36.4±3.2周，不包括2例妊娠23周和24周的早产。22名婴儿（46.9%）通过剖宫产分娩，其他婴儿经阴道分娩。除2例早产婴儿外，1例患有阿拉吉尔综合征母亲所生的婴儿死于先天性出生缺陷。其余新生儿存活。平均出生体重为2797±775g，38名婴儿（78%）体重超过2000g。出生体重相对于妊娠期的平均百分位数为54±23。4名婴儿（8.5%）出生体重百分位数低于25，28名婴儿（59.6%）出生体重百分位数高于50。12例患者在孕期出现无黄疸的肝酶升高。所有患者通过增加免疫抑制治疗均有反应。
本报告再次证实了他克莫司在肝移植术后妊娠期间的安全性。早产和低出生体重似乎是任何形式免疫抑制下所有实体器官移植中持续存在的问题。然而，使用他克莫司时妊娠中毒症和新发高血压的发生率似乎较低。
