Pregnancy after kidney and liver transplantation

A Wise; N E Diana; B Bobat; R T Saggers; S Bhoora; S Budhram; L Chauke; V G Lala; A Mahomed; D Mokgoko; M Seabi; B Moore; S Naidoo; R B Nyakoe; N Odell; G Paget; L Wium; J Zamparini

doi:10.7196/SAMJ.2024.v114i3b.1240

South African Medical Journal (Apr 2024)

Pregnancy after kidney and liver transplantation

A Wise,
N E Diana,
B Bobat,
R T Saggers,
S Bhoora,
S Budhram,
L Chauke,
V G Lala,
A Mahomed,
D Mokgoko,
M Seabi,
B Moore,
S Naidoo,
R B Nyakoe,
N Odell,
G Paget,
L Wium,
J Zamparini

Affiliations

A Wise: ORCiD; Department of Obstetrics and Gynaecology, Rahima Moosa Mother and Child Hospital and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
N E Diana: ORCiD; Division of Nephrology, Department of Internal Medicine, Charlotte Maxeke Johannesburg Academic Hospital and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
B Bobat: ORCiD; Department of Gastroenterology and Hepatology, Wits Donald Gordon Medical Centre, Johannesburg, South Africa
R T Saggers: ORCiD; Department of Paediatrics and Child Health, Charlotte Maxeke Johannesburg Academic Hospital and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
S Bhoora: ORCiD; Division of Maternal Critical Care, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas, USA; Department of Obstetrics and Gynaecology, Charlotte Maxeke Johannesburg Academic Hospital and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
S Budhram: ORCiD; Department of Obstetrics and Gynaecology, Tygerberg Hospital and Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
L Chauke: ORCiD; Department of Obstetrics and Gynaecology, Charlotte Maxeke Johannesburg Academic Hospital and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
V G Lala: ORCiD; Department of Gastroenterology and Hepatology, Wits Donald Gordon Medical Centre, Johannesburg, South Africa; Division of Medical Gastroenterology, Department of Internal Medicine, Charlotte Maxeke Johannesburg Academic Hospital and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
A Mahomed: ORCiD; Division of Medical Gastroenterology, Department of Internal Medicine, Charlotte Maxeke Johannesburg Academic Hospital and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
D Mokgoko: ORCiD; Division of Medical Gastroenterology, Department of Internal Medicine, Charlotte Maxeke Johannesburg Academic Hospital and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
M Seabi: ORCiD; Division of Medical Gastroenterology, Department of Internal Medicine, Charlotte Maxeke Johannesburg Academic Hospital and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
B Moore: ORCiD; Private Practice, Netcare Park Lane Hospital, Johannesburg, South Africa
S Naidoo: ORCiD; Division of Nephrology, Department of Internal Medicine, Charlotte Maxeke Johannesburg Academic Hospital and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
R B Nyakoe: ORCiD; Department of Obstetrics and Gynaecology, Charlotte Maxeke Johannesburg Academic Hospital and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
N Odell: ORCiD; Department of Obstetrics and Gynaecology, Charlotte Maxeke Johannesburg Academic Hospital and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
G Paget: ORCiD; Division of Nephrology, Department of Internal Medicine, Charlotte Maxeke Johannesburg Academic Hospital and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
L Wium: ORCiD; Women’s Services, King’s College Hospital, London, UK
J Zamparini: ORCiD; Obstetric Internal Medicine Unit, Department of Internal Medicine, Charlotte Maxeke Johannesburg Academic Hospital and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

DOI: https://doi.org/10.7196/SAMJ.2024.v114i3b.1240
Journal volume & issue: Vol. 114, no. 3b

Abstract

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Pregnancy in kidney and liver transplant recipients presents unique challenges and risks for both maternal and fetal health. This article examines the management of pregnancy in kidney and liver transplant recipients, focusing on pre-pregnancy counselling, trimester-specific care, the teratogenic effects of immunosuppressive drugs, and the role of the multidisciplinary team. While South African (SA) data on this topic are limited, the Transplant Pregnancy Registry International has provided valuable insights. Despite the increased risk of maternal and fetal complications, the overall risk of graft loss during pregnancy is low. Graft survival rates are comparable between pregnant and non- pregnant transplant recipients, except for pregnancies occurring within 1 year of transplantation. By addressing the complexities of managing pregnant women with kidney or liver transplants, this article underscores the importance of tailored care and the involvement of various medical specialists. It also explores the safety of and potential complications associated with specific immunosuppressive therapies during pregnancy. Further research is needed to enhance our understanding and optimise the management of these high-risk pregnancies in SA.

Published in South African Medical Journal

ISSN: 0256-9574 (Print); 2078-5135 (Online)
Publisher: South African Medical Association
Country of publisher: South Africa
LCC subjects: Medicine: Medicine (General)
Website: https://samajournals.co.za/index.php/samj/index

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