Casele H L, Laifer S A
University of Pittsburgh Health Sciences Center, Department of Obstetrics, Gynecology and Reproductive Sciences, Pennsylvania 15213, USA.
Transplantation. 1998 Feb 27;65(4):581-3. doi: 10.1097/00007890-199802270-00023.
The purpose of this study was to identify factors associated with antenatal complications for an ongoing series of pregnant women who have undergone orthotopic liver transplantation.
We reviewed Magee-Womens Hospital records from 14 pregnancies in 13 women in whom a liver had been transplanted before pregnancy. We collected and analyzed data regarding the primary liver disease, allograft status, liver function at conception and during pregnancy, immunosuppressive medications, associated medical conditions, time from transplant to conception, cytomegalovirus serostatus, and maternal and fetal outcome.
Seven patients had evidence of renal dysfunction (creatinine, 1.3-2.0 mg/dl), five of whom also were hypertensive at their first prenatal visit. The complications of preeclampsia, worsening hypertension, and small for gestational age occurred only in women with renal dysfunction at conception. Renal dysfunction was more often associated with cyclosporine than tacrolimus use.
Renal dysfunction is the primary determinant of adverse pregnancy outcome in liver transplant recipients. Immunosuppression with cyclosporine during pregnancy was more often associated with antenatal complications than with the use of tacrolimus.
本研究的目的是确定一系列接受原位肝移植的孕妇发生产前并发症的相关因素。
我们回顾了 Magee 妇女医院 13 名女性 14 次妊娠的记录，这些女性在怀孕前已接受肝脏移植。我们收集并分析了有关原发性肝脏疾病、移植肝状态、受孕时及孕期的肝功能、免疫抑制药物、相关疾病、移植至受孕的时间、巨细胞病毒血清学状态以及母婴结局的数据。
7 例患者有肾功能不全的证据（肌酐水平为 1.3 - 2.0 mg/dl），其中 5 例在首次产前检查时也患有高血压。子痫前期、高血压加重和小于胎龄儿等并发症仅发生在受孕时存在肾功能不全的女性中。肾功能不全与使用环孢素的相关性高于他克莫司。
肾功能不全是肝移植受者不良妊娠结局的主要决定因素。孕期使用环孢素进行免疫抑制比使用他克莫司更常与产前并发症相关。
