Barrou B M, Gruessner A C, Sutherland D E, Gruessner R W
Department of Surgery, University of Minnesota, Minneapolis 55455, USA.
Transplantation. 1998 Feb 27;65(4):524-7. doi: 10.1097/00007890-199802270-00012.
As of December 31, 1996, a total of 9012 pancreas transplants have been reported to the International Pancreas Transplant Registry (IPTR). Over 75% of these recipients were < or = 40 years of age at the time of their transplant. With continued improvement in short- and long-term outcome after transplant, an increasing number of female recipients have become pregnant. However, outcome after pregnancy in pancreas transplant recipients has not been studied in detail.
To evaluate the risks of pregnancy after pancreas transplantation in the cyclosporine era, we surveyed the institutions reporting to the IPTR.
Nineteen cases of pregnancy in 17 female recipients of simultaneous pancreas-kidney transplants resulted in 19 live births. Metabolic control during pregnancy was good in all cases. Mean duration of gestation was 35.2-2.2 weeks. Mean birth weight was 2150+/-680 g. Two congenital malformations were reported (one bilateral cataract and one double aortic arch). One child developed type I diabetes at age 3 years. Only one pancreas graft and one kidney graft were lost (in two different recipients). The pancreas graft was lost after delivery (because of acute rejection). The kidney graft was lost 3 months after delivery (impaired function due to previous amphotericin B treatment). One case of a worsened secondary complication (retinopathy) was reported. One recipient died of myocardial infarction 7 years after transplant and 5 years after delivery, in spite of a normal pretransplant coronary angiogram and good pancreas function.
This study shows that simultaneous pancreas-kidney transplantation can restore fertility in uremic type I diabetic female recipients. Thus, both posttransplant contraception and fertility counseling are options for female recipients. However, our analysis demonstrates that, when discussing the possibility of pregnancy with female pancreas recipients, these potential risks must be considered: (1) graft loss, (2) progressive maternal morbidity and mortality even with good glycemic control, and (3) diabetes transmission to offspring.
截至1996年12月31日，国际胰腺移植登记处（IPTR）共报告了9012例胰腺移植病例。这些接受者中超过75%在移植时年龄小于或等于40岁。随着移植后短期和长期疗效的不断改善，越来越多的女性接受者怀孕。然而，胰腺移植接受者怀孕后的结局尚未得到详细研究。
为评估环孢素时代胰腺移植后怀孕的风险，我们对向IPTR报告的机构进行了调查。
17例同时接受胰腺-肾脏移植的女性接受者中有19例怀孕，共分娩19例活产婴儿。所有病例孕期的代谢控制良好。平均妊娠期为35.2 - 2.2周。平均出生体重为2150±680克。报告了2例先天性畸形（1例双侧白内障和1例双主动脉弓）。1名儿童在3岁时患I型糖尿病。仅1例胰腺移植物和1例肾脏移植物丢失（在2名不同的接受者中）。胰腺移植物在分娩后丢失（由于急性排斥反应）。肾脏移植物在分娩后3个月丢失（因先前接受两性霉素B治疗导致功能受损）。报告了1例继发性并发症（视网膜病变）恶化的病例。1名接受者在移植后7年、分娩后5年死于心肌梗死，尽管移植前冠状动脉造影正常且胰腺功能良好。
本研究表明，同时进行胰腺-肾脏移植可使尿毒症I型糖尿病女性接受者恢复生育能力。因此，移植后避孕和生育咨询对女性接受者都是可行的选择。然而，我们的分析表明，在与女性胰腺接受者讨论怀孕可能性时，必须考虑这些潜在风险：（1）移植物丢失；（2）即使血糖控制良好，母亲仍有逐渐增加的发病和死亡风险；（3）糖尿病遗传给后代。
