Yuksel Yucel, Yuksel Deniz, Yucetin Levent, Erbis Halil, Sarier Mehmet, Karatas Ozlem, Emek Mestan, Erdogan Mine, Yavuz Asuman, Demirbas Alper
Department of General Surgery and Transplantation, Medical Park Hospital, Antalya, Turkey; Department of Surgery, University of Kyrenia, Kyrenia, Cyprus.
Department of Anesthesia and Reanimation Unit, Training and Research Hospital, Antalya, Turkey.
Transplant Proc. 2019 Sep;51(7):2361-2366. doi: 10.1016/j.transproceed.2019.01.150. Epub 2019 Aug 8.
Motherhood is the greatest privilege that nature gives to women. Although pregnancy is a physiological event for women, every pregnancy is a risky pregnancy. During a normal pregnancy, the health of mother and baby are monitored. In post-transplantation pregnancies, the function of the transplanted organ, along with the mother and the infant, must be monitored, since the continuation of pregnancy depends on both the maternal and infant health and an organ functioning within normal limits. The desire is for every baby to be born in due time and at normal weight, but this is not always possible in pregnancies after transplants. Publications about the pharmocokinetics of tacrolimus are very limited. In this study, we wanted to share our experiences with pregnancy in our clinic.
Patients who used tacrolimus during their pregnancies after renal transplantation (RT) at Antalya Medicapark Organ Transplantation Unit, during November 2008 to July 2018 were included in the study. Patient's gestational age, pregnancy, drug levels, is charge, and labor creatinine clearances were examined.
Four thousand six hundred thirty-five RT occurred between November 2008 to July 2018; 786 of the patients were female between the ages 18 and 45. Thirty-one pregnancies went full term. Twenty-six pregnant women, who used tacrolimus after RT, were included in the study. Five patients had pre-eclampsia, 1 patient had abortus immines, 2 patients had hypertansion due to pregnancy, and 1 patient had aplated placenta. There was a breech presentation in 1 patient with preeclampsia. Acute rejection developed in 3 postpartum patients, but renal values normalized with medical treatment. All the babies were born alive and healthy; postpartum graft loss was not observed.
If planning to become pregnant after RT,our center recommends waiting at least 2 years after the RT, when graft function should be normal and without any signs of HT and proteinuria. Our recommendation regarding the level of tacrolimus after RT is 4.5 to 7 μg.
为人母是大自然赋予女性的最大特权。尽管怀孕对女性来说是一个生理过程，但每次怀孕都有风险。在正常妊娠期间，会监测母婴的健康状况。在移植后妊娠中，由于妊娠的持续取决于母婴健康以及移植器官在正常范围内的功能，因此必须同时监测移植器官的功能以及母婴的情况。人们希望每个婴儿都能按时足月出生且体重正常，但在移植后的妊娠中这并非总是能够实现。关于他克莫司药代动力学的出版物非常有限。在本研究中，我们想分享我们诊所关于妊娠的经验。
纳入2008年11月至2018年7月在安塔利亚Medicapark器官移植科肾移植（RT）后妊娠期间使用他克莫司的患者。检查患者的孕周、妊娠情况、药物水平、收费情况以及分娩时的肌酐清除率。
2008年11月至2018年7月期间发生了4635例肾移植；其中786例患者为18至45岁的女性。31例妊娠足月。本研究纳入了26例肾移植后使用他克莫司的孕妇。5例患者患有先兆子痫，1例患者有难免流产，2例患者因妊娠出现高血压，1例患者有前置胎盘。1例先兆子痫患者出现臀位。3例产后患者发生急性排斥反应，但经药物治疗后肾功能值恢复正常。所有婴儿均健康存活；未观察到产后移植肾丢失。
如果计划在肾移植后怀孕，我们中心建议至少在肾移植后等待两年，此时移植肾功能应正常且无任何高血压和蛋白尿迹象。我们关于肾移植后他克莫司水平的建议是4.5至7μg。
