O'Donnell D, Sevitz H, Seggie J L, Meyers A M, Botha J R, Myburgh J A
Aust N Z J Med. 1985 Jun;15(3):320-5. doi: 10.1111/j.1445-5994.1985.tb04044.x.
During the 13 year period 1971 to 1984 there were 38 pregnancies in 21 renal transplant patients at the Johannesburg Hospital. Twenty-two ended with live births and included two sets of twins; there were nine spontaneous abortions, six therapeutic abortions, and one stillbirth. Maternal complications were mild in the majority but five patients suffered deterioration in renal function, two undergoing transplant nephrectomy as a result of this. There were seven neonatal deaths, including both sets of twins; death was due to prematurity in six and congenital malformation (diaphragmatic hernia) in one. A further infant had congenital pyloric stenosis which was corrected surgically. Pregnancies were analysed according to whether or not their outcome was successful. Those with a successful outcome had less exposure to warfarin during pregnancy (p = 0.0025) and showed a tendency towards lower immunosuppressive doses of prednisone and azathioprine although these did not reach significance. Although these results indicate an unhappy prognosis for both the mother and fetus, two redeeming features are to be noted. Pregnancy outcome improved markedly in the latter years, possibly owing to non-exposure to warfarin, less immunosuppression, and improvement in neonatal care, and four of the five mothers who suffered deterioration in renal function were notoriously unco-operative in their medical care. Pregnancy can only be recommended in the transplanted patient who has stable renal function, is compliant in taking of medications, and whose graft is of such age that the immunosuppressive drug dose is minimal. Warfarin should be avoided.
在1971年至1984年的13年期间，约翰内斯堡医院的21名肾移植患者共怀孕38次。其中22次以活产告终，包括两对双胞胎；有9次自然流产、6次治疗性流产和1次死产。大多数产妇并发症较轻，但有5名患者肾功能恶化，其中2名因此接受了移植肾切除术。有7名新生儿死亡，包括两对双胞胎；6名死于早产，1名死于先天性畸形（膈疝）。另有一名婴儿患有先天性幽门狭窄，已通过手术矫正。根据妊娠结局是否成功对妊娠进行了分析。结局成功的患者在孕期接触华法林的情况较少（p = 0.0025），并且泼尼松和硫唑嘌呤的免疫抑制剂量有降低的趋势，尽管未达到显著水平。尽管这些结果表明母亲和胎儿的预后都不理想，但有两个值得注意的可取之处。在后期，妊娠结局明显改善，这可能是由于未接触华法林、免疫抑制减少以及新生儿护理的改善，并且5名肾功能恶化的母亲中有4名在医疗护理方面极不配合。仅建议肾功能稳定、依从药物治疗且移植肾年龄使得免疫抑制药物剂量最小的移植患者怀孕。应避免使用华法林。
