Rayes N, Neuhaus R, David M, Steinmüller T, Bechstein W O, Neuhaus P
Department of Surgery, Virchow Clinic, Berlin, Germany.
Clin Transplant. 1998 Oct;12(5):396-400.
The number of pregnancies following liver transplantation is increasing due to better patient and graft survival and quality of life. Out of 156 women of a reproductive age, there were 19 pregnancies in 16 women, 12 on CsA and seven on tacrolimus, which occurred between 7/92 and 1/97. The median age of the women was 27.9 yr, median time after transplantation 33 months. There were four spontaneous and two induced abortions in the first trimenon. Ten women delivered ten healthy babies; three newborns had problems (alcoholic embryopathy due to recurrent alcohol abuse of his mother, pneumonia, weight < 2000 g). In eight women mostly mild complications were observed, such as hypertension (n = 5), nonspecific elevation of liver enzymes (n = 2), infection (n = 3) and premature labor (n = 1). Mean gestational age was 39 wk and mean birth weight 2900 g. One case of prematurity and three cases of growth retardation occurred. Cesarean sections were performed in 7 patients (54%) for maternal hypertension (n = 2), presumed fetal hypoxia (n = 4) and breech position (n = 1). All children are normally developed, the oldest being 5 yr old. Although experience with tacrolimus is limited, pregnancies following liver transplantation carry an acceptable risk if carefully monitored by an experienced team of transplant surgeons and obstetricians.
由于患者及移植物存活率提高以及生活质量改善，肝移植后妊娠的数量正在增加。在156名育龄妇女中，16名妇女共妊娠19次，其中12名妇女使用环孢素，7名妇女使用他克莫司，妊娠发生在1992年7月至1997年1月期间。这些妇女的中位年龄为27.9岁，移植后的中位时间为33个月。孕早期有4例自然流产和2例人工流产。10名妇女分娩了10名健康婴儿；3名新生儿出现问题（1名因母亲反复酗酒导致酒精性胚胎病，1名患肺炎，1名体重<2000克）。8名妇女主要出现轻度并发症，如高血压（5例）、肝酶非特异性升高（2例）、感染（3例）和早产（1例）。平均孕周为39周，平均出生体重为2900克。发生了1例早产和3例生长迟缓。7例患者（54%）因母亲高血压（2例）、推测胎儿缺氧（4例）和臀位（1例）而行剖宫产。所有儿童发育正常，最大的5岁。虽然他克莫司的经验有限，但如果由经验丰富的移植外科医生和产科医生团队仔细监测，肝移植后的妊娠风险是可以接受的。
