Sibanda Nokuthaba, Briggs J Douglas, Davison John M, Johnson Rachel J, Rudge Chris J
Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK.
Transplantation. 2007 May 27;83(10):1301-7. doi: 10.1097/01.tp.0000263357.44975.d0.
Maternal and fetal complications in pregnancies after renal transplantation have been highlighted in several reports, but information on their main predisposing factors is limited. The U.K. Transplant Pregnancy Registry was established in 1997 to obtain detailed information on pregnancies in female organ transplant recipients across the U.K.
For each female kidney, liver, or cardiothoracic organ transplant recipient who had had a recent pregnancy, data on maternal and fetal factors and pregnancy outcomes were collected using forms completed by their transplant follow-up and obstetric units. For kidney transplant recipients, the factors that influence pregnancy outcome were studied using logistic regression, and the effect of pregnancy on graft function was analyzed.
There were live births in 83%, 69%, and 79% of pregnancies in cardiothoracic organ, liver, and kidney recipients, respectively. In 50% of live births from renal patients, delivery was preterm (<37 weeks), with 83% of the preterm infants delivered via caesarean. Preterm delivery was associated with maternal drug-treated hypertension and impaired renal function. A matched case-control study showed no evidence of increased renal allograft loss after pregnancy. A univariate survival analysis, however, suggested an association between drug-treated hypertension during pregnancy and poorer postpregnancy graft survival. In patients with prepregnancy serum creatinine (SCr) >150 micromol/L, a trend toward increased postpregnancy SCr was identified.
Pregnancy is likely to end in a live birth in a majority of organ transplant recipients. In patients with greater prepregnancy SCr and/or drug-treated hypertension during pregnancy, however, subsequent renal function may be adversely affected.
肾移植术后妊娠的母婴并发症在多篇报道中已有提及，但关于其主要诱发因素的信息有限。英国移植妊娠登记处成立于1997年，旨在获取全英国女性器官移植受者妊娠的详细信息。
对于近期妊娠的每位女性肾、肝或心胸器官移植受者，通过其移植随访和产科单位填写的表格收集母婴因素及妊娠结局的数据。对于肾移植受者，采用逻辑回归研究影响妊娠结局的因素，并分析妊娠对移植肾功能的影响。
心胸器官、肝和肾移植受者的妊娠活产率分别为83%、69%和79%。肾移植患者活产中有50%为早产（<37周），其中83%的早产儿通过剖宫产分娩。早产与母亲药物治疗的高血压和肾功能受损有关。一项匹配病例对照研究未发现妊娠后肾移植丢失增加的证据。然而，单变量生存分析表明，妊娠期间药物治疗的高血压与妊娠后移植肾较差的生存率之间存在关联。在妊娠前血清肌酐（SCr）>150微摩尔/升的患者中，发现妊娠后SCr有升高趋势。
大多数器官移植受者的妊娠可能以活产告终。然而，对于妊娠前SCr较高和/或妊娠期间接受药物治疗的高血压患者，其后续肾功能可能会受到不利影响。
