Stratta Piero, Canavese Caterina, Giacchino Franca, Mesiano Paola, Quaglia Marco, Rossetti Maura
Department of Internal Medicine, Nephrology Section, University of Turin, S. Giovanni Molinette Hospital, Turin, Italy.
J Nephrol. 2003 Nov-Dec;16(6):792-806.
Since the first successful case of a pregnancy reported 40 yrs ago in a woman receiving a kidney transplant from her identical twin sister who did not receive immunosuppressive medications, the dream of a pregnancy in a renal transplant recipient has become reality. In women of childbearing age with a functioning transplant, the pregnancy rate has improved from 2 to 5%. Approximately 35% of pregnancies do not progress beyond the 1st trimester; the success rate is > 90% after the 1st trimester. In this review, different aspects of this topic are discussed: the consequences of pregnancy on renal grafts and maternal morbidity (hemodynamic changes, immunological problems, hypertension/preeclampsia, urinary tract infections and renal damage progression), the influence of renal grafts on pregnancy (perinatal mortality, prematurity, intrauterine growth retardation, low birth weight, malformations, handicaps and immunological problems) and the role of drugs used for renal transplants. A pregnancy can have a successful outcome if pre-conceptional graft function is good, if hypertension is absent and if the interval from grafting is at least 2 yrs. However, the majority of live-born outcomes are premature and many are low birth weight. Recipients must be advised that their offspring can also suffer from immunological abnormalities, malformations, long-term handicaps, and that the deleterious effects of pregnancy on long-term graft function cannot be excluded. In conclusion, women of childbearing age who have had renal transplantation should be counselled before conception about possibility and risks of pregnancy.
自40年前首例成功妊娠的病例报道以来，一名接受同卵双胞胎姐妹肾脏移植且未接受免疫抑制药物治疗的女性成功怀孕，肾移植受者怀孕的梦想已成为现实。在移植功能良好的育龄女性中，怀孕率已从2%提高到5%。大约35%的妊娠在孕早期后无法继续；孕早期后成功率>90%。在本综述中，将讨论该主题的不同方面：妊娠对肾移植和孕产妇发病率的影响（血流动力学变化、免疫问题、高血压/先兆子痫、尿路感染和肾损害进展）、肾移植对妊娠的影响（围产期死亡率、早产、宫内生长受限、低出生体重、畸形、残疾和免疫问题）以及肾移植所用药物的作用。如果孕前移植功能良好、无高血压且移植间隔至少2年，妊娠可能会有成功的结局。然而，大多数活产结局是早产，许多是低出生体重。必须告知受者，其后代也可能患有免疫异常、畸形、长期残疾，并且不能排除妊娠对移植长期功能的有害影响。总之，已接受肾移植的育龄女性在受孕前应接受有关妊娠可能性和风险的咨询。
