TRANSPLANTE RENAL E GRAVIDEZ





TRANSPLANTE RENAL E GRAVIDEZ

(especial para SIIC © Derechos reservados)
Nosso grupo, na Universidade Federal de São Paulo - Brasil tem acumulado experiência nesses casos e neste trabalho relatamos nossa experiência comparando com os dados obtidos na literatura. Nós enfatizamos que somente o acompanhamento multiprofissional levará aos melhores resultados.
deoliveira9.jpg Autor:
Leandro Gustavo De Oliveira
Columnista Experto de SIIC

Institución:
Universidade Federal de São Paulo


Artículos publicados por Leandro Gustavo De Oliveira
Coautores
Nelson Sass* José Osmar Medina Pestana* John M Davison** 
Universidade Federal de São Paulo, São Paulo, Brasil*
Newcastle University, Newcastle upon Tyne, Reino Unido**
Recepción del artículo
26 de Diciembre, 2007
Aprobación
22 de Febrero, 2008
Primera edición
1 de Julio, 2008
Segunda edición, ampliada y corregida
7 de Junio, 2021

Resumen
Pacientes com insuficiência renal crônica são frequentemente inférteis e a taxa de gravidez gira em torno de 1:200. Perda da libido, disfunção ovariana, amenorréia e elevados níveis de prolactina contribuem para a infertilidade. Após o transplante, entretanto, a fertilidade pode retornar rapidamente e a as taxas de gravidez passam para 1:50. Não há dúvidas de que essas mulheres constituem um grupo de alto risco e de elevadas taxas de problemas tanto maternos quanto perinatais. Desde a primeira gravidez de sucesso em uma portadora de transplante renal relatada em 1963, diversas publicações têm focado maiores incidências de síndromes hipertensivas, anemia, perda da função renal, pré-eclâmpsia, prematuridade, ruptura prematura de membranas, restrição de crescimento fetal e óbito perinatal. Nosso grupo, na Universidade Federal de São Paulo - Brasil tem acumulado experiência nesses casos e neste trabalho relatamos nossa experiência comparando com os dados obtidos na literatura. Nós enfatizamos que somente o acompanhamento multiprofissional levará aos melhores resultados. Por fim, gostaríamos de manifestar o nosso desejo de entrar em contato com outros grupos para discussão desses casos e então aprendermos juntos.

Palabras clave
insuficiência renal crônica, gravidez, transplante renal, drogas imunossupressoras


Artículo completo

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Extensión:  +/-6.1 páginas impresas en papel A4
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Abstract
Patients with chronic renal insufficiency are frequently infertile and the incidence of pregnancy is 1:200. Loss of libido, ovarian dysfunction, anovulatory vaginal bleeding, amenorrhea and high prolactin levels, all contribute to this infertility. However, after renal transplantation fertility can return rapidly with the chances of pregnancy increasing to about 1:50. There is no doubt that these women are a special high risk group with the potential for both maternal and perinatal problems. Since the first successful pregnancy was reported in 1963 many other publications have emphasized the increased incidence of hypertension, anaemia, renal function deterioration, pre-eclampsia, preterm delivery, preterm rupture of membranes, fetal growth restriction and stillbirths. At the Federal University of Sao Paulo - Brazil, we have emphasized that a multidisciplinary team approach is essential for their care and in this article we document and analyze the lessons learnt from our significant single centre experience. We would be happy in contacting other groups of specialists interested in this special group of patients to discuss and learn together.

Key words
chronic renal insufficiency, pregnancy, immunosupresor drugs, renal transplantation


Clasificación en siicsalud
Artículos originales > Expertos de Iberoamérica >
página   www.siicsalud.com/des/expertocompleto.php/

Especialidades
Principal: Trasplantes
Relacionadas: Nefrología y Medio Interno, Obstetricia y Ginecología



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Enviar correspondencia a:
Leandro Gustavo de Oliveira, Departamento de Obstetrícia da Universidade Federal de São Paulo - Brasil., CEP: 04024, Rua Napoleão de Barros, 875., São Paulo, Brasil
Bibliografía del artículo
1. Lockwood GM, Ledger WL, Barlow DH. Successful pregnancy outcome in a renal transplant patient following in vitro fertilization. Human Reprod 10:1528-31, 1995.
2. Sturgiss SN, Davison JM. Effect of pregnancy on long-term function of renal allografts. Am J Kidney Dis 19:167-72, 1992.
3. Marshall D, Lindheimer MD, Katz AI. Pregnancy in the renal transplant patient. Am J Kidney Dis 19:173-6, 1992.
4. Sousa CTBC. Gravidez após transplante renal: impacto da gestação na função enxerto e da imunossupressão sobre o feto. [Tese]. São Paulo: Universidade Federal de São Paulo, 2002.
5. Murray JE, Ried DE, Harrison JH, Merril JP. Succcesfull pregnancies after human renal transplantation. N Engl J Med 269:341-3, 1963.
6. Davison JM. The effect of pregnancy on kidney function in renal allograft recipients. Kidney Int 27:74-9, 1985.
7. Davison JM, Bailey DJ. Pregnancy following renal transplantation. J Obstet Gynaecol Res 29(4):227-33, 2003.
8. Thompsom BC, Kingdon EJ, Tuck SM, Fernando ON, Sweny P. Pregnancy in renal transplant recipients: the Royal Free Hospital experience. Q J Med 96:837-44, 2003.
9. O'Donnell D, Sevitz H, Seggie JL, Meyers AM, Botha JR, Myburgh JA. Pregnancy after renal transplantation. Aust NZ J Med 15:320-5, 1985.
10. O'Connell PJ, Caterson RJ, Stewart JH, Mahony JF. Problems associated with pregnancy in renal allograft recipients. Int J Artif Organs 12:147-52, 1989.
11. Davison JM. Dialysis, Transplantation and pregnancy. Am J Kidney Dis 17:127-32, 1991.
12. Shohaib SA. Erythropoietin therapy in a pregnant post-renal transplant patient. Nephron 81:81-3, 1999.
13. Bakr MA, Ghaneim MES, Fouda MA, Sally S, Moustafa FE, Sobh MA, Ghoneim MA. Clinical course and outcome of pregnancies recipients of renal allografts. Transplant Proc 29:2787-9, 1997.
14. Oliveira LG, Sass N, Sato JL, Ozaki KS, Pestana JOM. Pregnancy after renal transplantation - a five-yr single-center experience. Clin Transpl 21(3):301-4, 2007.
15. Oliveira LG. As intercorrências clínicas, obstétricas e os resultados perinatais em grávidas portadoras de transplante renal. [Tese]. São Paulo: Universidade Federal de São Paulo, 2004.
16. Penn I, Makowski EL, Harris P. Parenthood following renal and hepatic transplantation. Transplantation 30(6):397-400, 1980.
17. Armenti VT, Ahlswede KM, Ahlswede BA, Jarrell BE, Moritz MJ, Burke JF. National transplantation pregnancy registry - Outcomes of 154 pregnancies in cyclosporine - treated female kidney transplant recipients. Transplantation 57:502-6, 1994.
18. Duley L. Pre-eclampsia and the hypertensive disorders of pregnancy. British Medical Bulletin 67:161-76, 2003.
19. Borzychowski AM, Sargent IL, Redman CWG. Inflammation and pre-eclampsia. Seminars in Fetal & Neonatal Medicine 11:309-16, 2006.
20. Little MA, Abraham KA, Kavanagh J, Connolly G, Byrne P, Walshe JJ. Pregnancy in Irish renal transplant recipients in the ciclosporine era. Ir J Med Sci 169:19-21, 2000.
21. Muirhead N, Sabharwal AR, Rieder MJ, Lazarovitz AI, Hollomby DJ. The outcome of pregnancy following renal transplantation - The experience of a single center. Transplantation 54:429-32, 1992.
22. Jones DC; Hayslett JP. Outcome of pregnancy in women with moderate or severe renal insufficiency. N Engl J Med 335:226-32, 1996.
23. Cunninghan FG, Gant NF, Leveno KJ, Gilstrap LC, Hauth JC, Wenstron KD. In: Renal and urinary tract disorders. Williams Obstetrics 21st ed. United States of America: McGraw-Hill; pp. 1251-71, 2001.
24. Crowe AV, Rustom R, Gradden C. Pregnancy does not adversaly affect renal transplant function. Q J Med 92:631-5, 1999.
25. McKay DB, Josephson MA. Pregnancy in Recipients of solid organs - effects on mother and child. Lancet 354:1281-93, 2006.
26. Sarrikoski S, Seppala M. Imunossupression during pregnancy. Transmission of azathioprine and its metabolites from the mother to the fetus. Am J Obstet Gynaecol 115:1100-6, 1973.
27. Davison JM, Lindheimer MD. Pregnancy in renal transplant recipients. J Reprod Med 27:613-21, 1982.
28. Cararach V, Carmona F, Monleón FJ, Andreu J. Pregnancy after renal transplantation: 25 years experience in Spain. Br J Obstet Gynaecol 100:122-5, 1993.
29. Pirson Y, Van Lierde M, Ghysen J, Squifflet JP, Alexandre GPL, De Strihou CVY. Retardation of fetal growth in patients receiving imunossupressive therapy. N Engl J Med 313:328-32, 1985.
30. Hou S. Pregnancy in organ transplant recipients. Medical clinics of North America 73:667-83, 1989.
31. Armenti VT. Immunosuppression and teratology: Evolving Guidelines. J Am Soc Nephrol 15:2759-60, 2004.
32. Sgro MD, Barozzino T, Mirghani HM, Sermer M, Moscato L, Akoury H, Koren G, Chitayat DA. Pregnancy outcome post renal transplantation. Teratology 65:5-9, 2002.
33. Kainz A, Harabacz I, Cowrick IS, Gadgil I, Hagiwara D. Analysis of 100 pregnancy outcomes in womem treated systemically with tacrolimus. Transplant Int 13(Suppl.1):S299-300, 2000.
34. Packham DK, Lam SS, Nicholls K, Fairley KF, Kincaid-Smith P. Mycophenolato mofetil in pregnancy after renal tranplantation: a case of major fetal malformation. Obstet Gynecol 103(5PT2):1091-4, 2004.
35. Moretti ME, Sgro M, Johnson DW, Sauve RS, Woolgar MJ, Taddio A, Verjee Z, Giesbrecht E, Koren G, Ito S. Cyclosporine excretion into breast milk. Transpl 75(12):2144-6, 2003.
36. Gardiner SJ, Begg EJ. Breastfeeding during tacrolimus therapy. Obstet Gynecol 107(2 Pt 2):453-5, 2006.
37. Committee on Drugs, American Academy of Pediatrics. The transfer of drugs and other chemicals into human milk. Pediatrics 93:137-50, 1994.

 
 
 
 
 
 
 
 
 
 
 
 
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