Wong K M, Bailey R R, Lynn K L, Robson R A, Abbott G D
Department of Nephrology, Christchurch Hospital.
N Z Med J. 1995 May 24;108(1000):190-2.
Assess the pregnancies of our female renal transplant recipients and to document long term maternal and fetal outcome.
Between 7 June 1972 and 31 December 1992 112 females had at least one renal transplant. Sixty-four of these 112 women were in the reproductive age and had a functioning graft.
Nine women had 16 pregnancies which resulted in 11 live births and three first trimester abortions. Two unplanned pregnancies were terminated. Mean age at transplantation was 17.2 yr [range 16-22.5 yr] and mean interval from transplant to pregnancy was 6.8 yr [range 1.8-9.0 yr]. Prednisone and azathioprine were used in all patients and cyclosporin in five. For seven of the successful pregnancies plasma creatinine remained < or = 0.10 mmol/L. One of these women developed allograft nephropathy 5 years after delivery and returned to dialysis 9 years later. For the other four successful pregnancies the preconception plasma creatinine was 0.12-0.14 mmol/L. The woman with two successful pregnancies had a halving of glomerular filtration rate during the second pregnancy, but it has remained stable for 15 years; one was poorly compliant with her immunosuppressive regimen and reached endstage renal failure two years after delivery; one developed cyclosporin nephrotoxicity, but 18 months later renal function was stable after a dosage reduction. Ten infants were delivered by caesarean section, four of them urgently. Three babies were preterm and five growth retarded. One died of sudden infant death syndrome at four months. All other infants developed normally.
There is no contraindication to pregnancy in female transplant recipients who have stable graft function and controlled blood pressure. Management of such pregnancies should be by shared obstetrical/nephrological/paediatric care.
评估女性肾移植受者的妊娠情况，并记录母婴长期结局。
1972年6月7日至1992年12月31日期间，112名女性接受了至少一次肾移植。这112名女性中有64名处于生育年龄且移植肾功能良好。
9名女性怀孕16次，其中11次分娩活婴，3次妊娠早期流产。2次意外怀孕终止妊娠。移植时平均年龄为17.2岁（范围16 - 22.5岁），移植至怀孕的平均间隔时间为6.8年（范围1.8 - 9.0年）。所有患者均使用泼尼松和硫唑嘌呤，5名患者使用环孢素。7次成功妊娠的患者血浆肌酐水平均≤0.10 mmol/L。其中1名女性产后5年发生移植肾肾病，9年后重新开始透析。另外4次成功妊娠的患者孕前血浆肌酐水平为0.12 - 0.14 mmol/L。有2次成功妊娠的女性在第二次妊娠期间肾小球滤过率减半，但15年来一直保持稳定；1名女性对免疫抑制方案依从性差，产后两年发展为终末期肾衰竭；1名女性发生环孢素肾毒性，但18个月后减量后肾功能稳定。10名婴儿通过剖宫产分娩，其中4名是急诊剖宫产。3名婴儿早产，5名发育迟缓。1名婴儿在4个月时死于婴儿猝死综合征。其他所有婴儿发育正常。
移植肾功能稳定且血压得到控制的女性移植受者妊娠并无禁忌。此类妊娠的管理应由产科、肾科和儿科共同护理。
