Management of pregnancy in transplant recipients.

Transplantation offers the best prospect of pregnancy in fertile women with various types of end-stage organ disease. Based on data from the USA National Transplantation Pregnancy Registry, >70% of posttransplant pregnancies have a successful live birth. Greatest experience has been seen in transplants involving the kidney, followed by the liver and then heart. Most pregnancies do not affect graft function significantly but are associated with significant obstetric problems such as spontaneous abortions, premature deliveries, low birthweight, intrauterine growth retardation, preeclampsia, etc. Cesarian section is required in 30% to 50% of patients, due to obstetric or maternal concerns. Neonatal death is rare, but 30% to 50% of live births have complications. Thus, management requires a multidisciplinary team. Similar data have been documented in developed Asian countries such as Japan and Singapore. Although fertility is restored early (<6 months), the current recommendation is to wait for >/=1 year, if not 2 years, after transplantation before allowing pregnancy. Patients without evidence of graft dysfunction and hypertension are more likely to have successful outcomes. Acute rejections may occur but the incidence does not appear to be increased dramatically. Treatment should be to similar to that of nonpregnancy treatment. Further pregnancies may be considered in instances of good outcome for the graft, fetus, and mother. Significant experience and safety has been accumulated in treatment using cyclosporine, azathioprine, prednisolone, and tacrolimus. However, few data are available with regard to the newer immunosuppressants, such as mycophenolate mofetil, and thus these agents are not recommended. Most live births have normal growth and development. Although there is much information available on posttransplant pregnancy it is imperative that each center maintains its own registry of pregnancy and offspring outcomes.