Pregnancy After Transplantation
INTRODUCTION
Transplantation is
now an accepted therapeutic option for patients with end-stage organ failure.
The first successful human kidney transplant took place in 1954.[1]
However, it was not until the 1960s that immunosuppression became available and
not until the 1980s, with the introduction of cyclosporine, that consistently
acceptable graft and patient survival was achieved. With the restoration of
organ function, patients experience an overall improvement in their health,
increased libido, and return of fertility.
The first
post-transplant pregnancy occurred in March 1958 and was reported in 1963. It
occurred in a patient who had received a kidney from her identical twin.[2]
This pregnancy resulted in cesarean delivery of a healthy boy. As
transplantation has progressed, with improvements in surgical techniques and
medical therapy and advances in immunosuppression, pregnancies have been
reported in recipients of each organ type. Most outcomes reported are in kidney
transplant recipients. Issues that must be considered include maternal graft
function and maternal health, the effect of pregnancy on graft function, and
the effect of the medications and graft function on the developing fetus. There
is also concern about the long-term effects of pregnancy on graft function.
Finally, there is the question of whether more subtle and long-term effects,
although not apparent at birth, may affect the growth and development of the
offspring of these recipients or future generations. These issues are discussed
in this chapter.