Spearman C W N, Goddard E, McCulloch M I, Hairwadzi H N, Sonderup M W, Kahn D, Millar A J W
Red Cross War Memorial Children's Hospital, University of Cape Town Medical School, Cape Town, South Africa.
Pediatr Transplant. 2011 Nov;15(7):712-7. doi: 10.1111/j.1399-3046.2011.01554.x.
More than 80% of pediatric transplant recipients will survive to reach adulthood, and many will consider having children. We report on outcomes and management of five pregnancies in four women undergoing orthotopic liver transplantation during childhood or adolescence and followed up at our Transplant Center. A retrospective clinical folder audit was performed. Mean age at transplantation was 13.3 ± 3.4 yr (range, 10-18 yr). Mean interval between transplantation and pregnancy was 15.4 ± 4.9 yr (range, 10-22 yr). Mean maternal age at conception was 28 ± 3.5 yr (range, 23-32 yr). Mean gestational age was 36.6 ± 1.7 wk. Mean birth weight was 2672 ± 249 g. Immunosuppression was cyclosporin based in three women and tacrolimus based in one woman. Pregnancy complications necessitating the induction of labor included fetal distress and rising maternal liver enzymes in two women, cholestasis of pregnancy and impaired renal graft function in one woman, fetal distress and preeclampsia in one woman. Modes of delivery were normal vaginal delivery in three women and cesarean section in one woman. No maternal or fetal deaths and no congenital malformations occurred. No episodes of rejection occurred during pregnancy. Two women experienced acute cellular rejection requiring an increase in baseline immunosuppression in the first year, following delivery. No graft losses occurred during a mean follow-up of 44 ± 17.9 months post-delivery. With careful management, pregnancy post-liver transplantation can have a successful outcome.
超过80%的儿童移植受者能够存活至成年，其中许多人会考虑生育。我们报告了4名在儿童期或青春期接受原位肝移植并在我们移植中心接受随访的女性的5次妊娠结局及管理情况。进行了回顾性临床病历审查。移植时的平均年龄为13.3±3.4岁（范围10 - 18岁）。移植与妊娠之间的平均间隔为15.4±4.9年（范围10 - 22年）。受孕时的平均母亲年龄为28±3.5岁（范围23 - 32岁）。平均孕周为36.6±1.7周。平均出生体重为2672±249克。3名女性以环孢素为基础进行免疫抑制，1名女性以他克莫司为基础。需要引产的妊娠并发症包括2名女性的胎儿窘迫和母亲肝酶升高、1名女性的妊娠胆汁淤积和肾移植功能受损、1名女性的胎儿窘迫和先兆子痫。分娩方式为3名女性顺产，1名女性剖宫产。未发生母亲或胎儿死亡，也未出现先天性畸形。妊娠期间未发生排斥反应。2名女性在产后第一年发生急性细胞排斥反应，需要增加基线免疫抑制。产后平均随访44±17.9个月期间未发生移植物丢失。通过精心管理，肝移植后妊娠可获得成功结局。
