Armenti Vincent T, Radomski John S, Moritz Michael J, Gaughan William J, Hecker William P, Lavelanet Antonella, McGrory Carolyn H, Coscia Lisa A
Department of Surgery, Temple University School of Medicine, Philadelphia, Pennsylvania, USA.
Clin Transpl. 2004:103-14.
The NTPR maintains an ongoing active database to study the safety of pregnancy in transplant recipients and currently includes the outcomes of more than 900 female recipients who became pregnant after their transplant and just over 700 male recipients who fathered one or more pregnancies after receiving a transplant. Analyses include the long-term follow-up of the recipient's graft status and their offspring. Successful pregnancy outcomes have been noted for each solid organ recipient group. The Registry includes information on 1,097 pregnancies in 716 kidney recipients, 187 pregnancies in 111 liver recipients, 56 pregnancies in 38 P/K recipients and smaller numbers for other organs and combinations of organs. There are periodic reports of recipients with graft dysfunction, rejection, or graft loss that may be related to pregnancy events, though the majority of outcomes reported to the NTPR appear favorable for parent and newborn. Organ-specific issues and comorbidities must also be considered in analyzing outcomes. The pregnancy issues that face recipients and caretakers with the current newer adjunctive therapies and newer immunosuppressive regimens require ongoing study. The potential risk of teratogenicity must be weighed against the potential risk of rejection when altering drug regimens before planned conceptions or in making dosage adjustments during pregnancy. Unplanned pregnancies present obvious concerns. Pregnancy safety has not been established for either MMF or sirolimus and all centers are encouraged to report pregnancies with exposures to these agents to the NTPR. Continuing analyses are directed at potential effects of the newer immunosuppressive regimens, not only to identify any risks to the pregnancy from immediate exposure, but also for potential postpartum exposures such as from breastfeeding. As the registry study design allows for continued contact, efforts continue to accrue long-term follow-up of both parent and child.
国家移植受者妊娠登记处（NTPR）维护着一个持续更新的动态数据库，用于研究移植受者妊娠的安全性。目前，该数据库包含了900多名移植后怀孕的女性受者以及700多名移植后成为一个或多个孩子父亲的男性受者的结局。分析内容包括对受者移植器官状态及其后代的长期随访。每个实体器官受者组都有成功的妊娠结局记录。该登记处包括716名肾移植受者的1097次妊娠、111名肝移植受者的187次妊娠、38名胰肾联合移植受者的56次妊娠以及其他器官或器官组合受者的少量妊娠信息。虽然向NTPR报告的大多数结局对父母和新生儿似乎是有利的，但仍有定期报告称受者出现了可能与妊娠事件相关的移植器官功能障碍、排斥反应或移植器官丢失。在分析结局时，还必须考虑器官特异性问题和合并症。当前新型辅助疗法和新型免疫抑制方案给受者及其护理人员带来的妊娠问题需要持续研究。在计划受孕前改变药物方案或在孕期进行剂量调整时，必须权衡致畸的潜在风险与排斥反应的潜在风险。意外怀孕令人担忧。霉酚酸酯（MMF）或西罗莫司的妊娠安全性尚未确定，鼓励所有中心向NTPR报告接触过这些药物的妊娠情况。持续分析针对新型免疫抑制方案的潜在影响，不仅要确定即刻接触对妊娠的任何风险，还要确定产后接触的潜在风险，如母乳喂养带来的风险。由于登记处的研究设计允许持续联系，因此仍在努力对父母和孩子进行长期随访。
