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22 - Pregnancy and transplantation

from Section 5 - Other disorders

Published online by Cambridge University Press:  19 October 2009

By
Kerri M. Robertson
Edited by
David R. Gambling ,
M. Joanne Douglas  and
Robert S. F. McKay
Kerri M. Robertson
Affiliation:
Associate Clinical Professor, Chief, GVTCCM Division Chief, Liver Transplantation Department of Anesthesiology, Duke University, Medical Center, Durham, NC, USA
David R. Gambling
Affiliation:
University of California, San Diego
M. Joanne Douglas
Affiliation:
University of British Columbia, Vancouver
Robert S. F. McKay
Affiliation:
University of Kansas
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Summary

Introduction

Transplantation is recognized as life saving for individuals suffering from end-stage organ failure. For many young women, improved transplant success rates and newer “obstetric-friendly” immunosuppressant drugs have allowed them the opportunity of achieving normal reproductive function, with the subsequent choice of childbearing. The most extensive experience with pregnancy in the posttransplant parturient has been in renal recipients with the first successful posttransplant pregnancy occurring in 1958. Since then, thousands of successful deliveries have been reported in women after liver, heart, simultaneous kidney–pancreas and combined transplants (heart–lung(s), liver–kidney, liver–heart, and liver–lung). Despite the inherent increased risk to the mother and concerns about the effects of immunosuppressive drugs on fetal development, and the effects of pregnancy on transplant function, a successful outcome in such pregnancies is achievable. Consensus is that in the presence of good graft function and with stable maintenance immunosuppressive drug therapy, pregnancy is well tolerated, with most pregnancies resulting in successful outcomes for mother and newborn. In addition, multiple pregnancies in a transplant recipient do not seem to increase the incidence of complications in the newborn or mother or augment graft dysfunction and failure.

Statistics

Organ transplantation has become a relatively common surgical procedure performed in over 250 centers worldwide, with improvement in both patient and graft survival rates reported over the past two decades. As such, many of these recipients are healthy and live a relatively normal life, with an excellent chance of survival during and beyond their reproductive years.

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Type
Chapter
Information
Obstetric Anesthesia and Uncommon Disorders , pp. 381 - 404
Publisher: Cambridge University Press
Print publication year: 2008

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  • Pregnancy and transplantation
    • By Kerri M. Robertson, Associate Clinical Professor, Chief, GVTCCM Division Chief, Liver Transplantation Department of Anesthesiology, Duke University, Medical Center, Durham, NC, USA
  • Edited by David R. Gambling, University of California, San Diego, M. Joanne Douglas, University of British Columbia, Vancouver, Robert S. F. McKay, University of Kansas
  • Book: Obstetric Anesthesia and Uncommon Disorders
  • Online publication: 19 October 2009
  • Chapter DOI: https://doi.org/10.1017/CBO9780511544552.023
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  • Pregnancy and transplantation
    • By Kerri M. Robertson, Associate Clinical Professor, Chief, GVTCCM Division Chief, Liver Transplantation Department of Anesthesiology, Duke University, Medical Center, Durham, NC, USA
  • Edited by David R. Gambling, University of California, San Diego, M. Joanne Douglas, University of British Columbia, Vancouver, Robert S. F. McKay, University of Kansas
  • Book: Obstetric Anesthesia and Uncommon Disorders
  • Online publication: 19 October 2009
  • Chapter DOI: https://doi.org/10.1017/CBO9780511544552.023
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  • Pregnancy and transplantation
    • By Kerri M. Robertson, Associate Clinical Professor, Chief, GVTCCM Division Chief, Liver Transplantation Department of Anesthesiology, Duke University, Medical Center, Durham, NC, USA
  • Edited by David R. Gambling, University of California, San Diego, M. Joanne Douglas, University of British Columbia, Vancouver, Robert S. F. McKay, University of Kansas
  • Book: Obstetric Anesthesia and Uncommon Disorders
  • Online publication: 19 October 2009
  • Chapter DOI: https://doi.org/10.1017/CBO9780511544552.023
Available formats
×