Dei Malatesta Marialuisa Framarino, Rossi Massimo, Rocca Bianca, Iappelli Massimo, Giorno Maria Pia, Berloco Pasquale, Cortesini Raffaello
Department of Gynecological Sciences and Perinatology, University of Rome La Sapienza School of Medicine Rome, Italy.
Transpl Immunol. 2006 Apr;15(4):297-302. doi: 10.1016/j.trim.2006.01.001. Epub 2006 Feb 9.
Improved survival and quality of life following liver transplantation are associated with an increased frequency of pregnancies in liver-transplanted women. We investigated the outcome, complications, and management of those pregnancies. We have reviewed the literature and report 8 pregnancies in 6 transplant recipients. Seven pregnancies were completed at 38+/-2 (mean+/-standard deviation) weeks. One miscarriage occurred at week 12. Newborns' weight averaged 2938+/-156 g. Main complications were preeclampsia (n=1) and reversible cholestasis (n=1). Among 285 pregnancies reported in literature, 78+/-20% were successful and the main complications were: preeclampsia (26+/-19%), hypertension (28+/-19%), reversible liver dysfunction (27+/-21%), cesarean delivery (23+/-10%), preterm birth (31+/-28%), small for gestational age infants (23+/-10%), rejection (10+/-7%). Gestational weeks were 36.7+/-1.3, perinatal mortality was 4+/-10%, malformation rate 3%. The rates of both abortions and complications (preeclampsia and/or hypertension) were inversely related to the time interval between transplantation and conception (p<0.05). Abortions occurred more often in recipients whose underlying disease was autoimmune cirrhosis than in recipients with inherited disorders. Rejection rate was approx. 10%, which appears higher than reported in a non-pregnant population after a comparable time interval from transplant (2-3%). Up to 28 months after delivery, maternal death was 5.5+/-7%. We conclude that: the time intervals between transplantation and conception as well as the original cause of liver failure influence the outcome and complications of pregnancies in liver recipients. However, neonatal survival is high, while malformations are relatively rare.
肝移植女性妊娠频率增加与肝移植后生存率提高及生活质量改善相关。我们调查了这些妊娠的结局、并发症及处理情况。我们回顾了文献并报告了6例移植受者的8次妊娠。7次妊娠在38±2（平均±标准差）周时完成。1次流产发生在孕12周。新生儿体重平均为2938±156克。主要并发症为子痫前期（n = 1）和可逆性胆汁淤积（n = 1）。文献报道的285次妊娠中，78±20%成功，主要并发症为：子痫前期（26±19%）、高血压（28±19%）、可逆性肝功能障碍（27±21%）、剖宫产（23±10%）、早产（31±28%）、小于胎龄儿（23±10%）、排斥反应（10±7%）。孕周为36.7±1.3，围产儿死亡率为4±10%，畸形率为3%。流产率及并发症（子痫前期和/或高血压）发生率均与移植与受孕的时间间隔呈负相关（p<0.05）。自身免疫性肝硬化患者比遗传性疾病患者流产更常见。排斥反应发生率约为10%，这似乎高于移植后相同时间间隔的非妊娠人群报道的发生率（2 - 3%）。产后长达28个月，孕产妇死亡率为5.5±7%。我们得出结论：移植与受孕的时间间隔以及肝衰竭的原发病因会影响肝移植受者妊娠的结局及并发症。然而，新生儿存活率高，而畸形相对少见。
