Armenti V T, Ahlswede K M, Ahlswede B A, Cater J R, Jarrell B E, Mortiz M J, Burke J F
Department of Surgery, Jefferson Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania 19107.
Transplantation. 1995 Feb 27;59(4):476-9.
Outcomes from 197 pregnancies in 141 female kidney transplant recipients were analyzed from data collected via questionnaires, hospital records, and phone interviews. All recipients were maintained on cyclosporine (CsA) before and during pregnancy. Of the livebirths, 54% were premature (< 37 wk) and 50% were low-birthweight (LBW) (< 2500 g). The incidence of recipient drug-treated hypertension (HTN) was 56%; preeclampsia, 29%; infections and complications 22%; and rejection during pregnancy and up to 3 mo. post delivery (rej.), 11%. Graft loss within 2 years of delivery occurred in 9% of recipients (GrL < 2). No recipients reported a pregnancy after a postpregnancy graft loss. Mean serum creatinine was reported before, during, and after pregnancy. Mean cyclosporine doses were similar in recipients during and after pregnancy. Data were analyzed by logistic regression using SAS. Outcomes included prematurity, LBW, rej., and GrL < 2. In a case-controlled study comparing a recipient group with graft dysfunction during pregnancy vs. a group with good graft function, there was a trend toward lower mean prepregnancy CsA doses (in mg/kg) in the graft dysfunction group. A decline in recipient graft function during pregnancy is associated with lower newborn birthweights and lower maternal graft survival in cyclosporine treated female kidney recipients. Pregnancy-related infections and complications are associated with rejection and graft loss in this population. Close monitoring of CsA dosing and serum creatinine levels during pregnancy and immediately postpartum is recommended as CsA dosage adjustment may be required.
通过问卷调查、医院记录和电话访谈收集的数据，对141名女性肾移植受者的197次妊娠结局进行了分析。所有受者在妊娠前和妊娠期间均接受环孢素（CsA）治疗。在活产儿中，54%为早产（<37周），50%为低出生体重儿（LBW，<2500g）。受者药物治疗的高血压（HTN）发生率为56%；先兆子痫为29%；感染和并发症为22%；妊娠期间及产后3个月内的排斥反应（rej.）为11%。9%的受者在分娩后2年内发生移植肾丢失（GrL<2）。没有受者报告在移植肾丢失后再次妊娠。报告了妊娠前、妊娠期间和妊娠后的平均血清肌酐水平。妊娠期间和妊娠后的受者中环孢素平均剂量相似。使用SAS通过逻辑回归分析数据。结局包括早产、低出生体重、排斥反应和GrL<2。在一项病例对照研究中，比较妊娠期间移植肾功能不全的受者组与移植肾功能良好的组，移植肾功能不全组妊娠前CsA平均剂量（mg/kg）有降低的趋势。在接受环孢素治疗的女性肾移植受者中，妊娠期间受者移植肾功能下降与新生儿低出生体重和母体移植肾存活率降低有关。在这一人群中，与妊娠相关的感染和并发症与排斥反应和移植肾丢失有关。建议在妊娠期间和产后立即密切监测CsA剂量和血清肌酐水平，因为可能需要调整CsA剂量。
