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Preconception counseling, fertility, and pregnancy complications after abdominal organ transplantation: a survey and cohort study of 532 recipients

机译：腹部器官移植后的孕前咨询，生育和妊娠并发症：对532名受者进行的调查和队列研究

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Background Pregnancy after solid organ transplant is a significant priority for transplant recipients but how patients report being counseled is unknown. Methods We performed a single‐center retrospective cohort study and telephone survey of female patients ages 18–49 at the time of kidney, pancreas, or liver transplant from 2000 to 2012 (n = 532). Data on pregnancy counseling, fertility, and maternal, fetal‐ and transplant‐specific outcomes were collected. Multivariate Cox models assessed the impact of pregnancy on graft‐specific outcomes. Results The survey response rate was 29% (n = 152). One‐third (n = 51) of women were actively counseled against pregnancy by one or more providers. A total of 17 pregnancies occurred among nine patients (5.9%), with 47% live births, 47% early embryonic demises, 5.9% stillbirths. Of live births, 50% were premature. Gestational complications, including diabetes, hypertension, and preeclampsia were present in 88% of mothers. Pregnancy after transplant was associated with higher rates of acute rejection than nulliparous transplant recipients (33% vs. 5.6%, p = 0.07) but did not significantly affect graft survival ( HR  = 1.00, 95% CI 0.99–1.01), after stratifying by organ and adjusting for clinical factors. Conclusion This study suggests that transplant patients are being counseled against pregnancy despite acceptable risks of complications and no specific effects on long‐term graft function.
机译：背景实体器官移植后的怀孕对于移植接受者来说是一个重要的优先事项，但是尚不清楚患者如何报告接受咨询。方法我们对2000年至2012年间肾脏，胰腺或肝移植时18-49岁的女性患者进行了单中心回顾性队列研究和电话调查（n = 532）。收集了有关妊娠咨询，生育能力以及母体，胎儿和移植特异性结局的数据。多元Cox模型评估了妊娠对移植物特异性结局的影响。结果调查回应率为29％（n = 152）。一名（或多名）提供者积极咨询了三分之一（n = 51）名妇女以防止怀孕。 9例患者（5.9％）中总共发生了17例怀孕，其中47％活产，47％早期胚胎死亡，5.9％死产。在活产中，有50％为早产。 88％的母亲有妊娠并发症，包括糖尿病，高血压和先兆子痫。经分层后，移植后妊娠与未接受移植者相比具有更高的急性排斥反应率（33％vs.5.6％，p = 0.07），但对移植存活率没有显着影响（HR = 1.00，95％CI 0.99-1.01）。器官和适应临床因素。结论这项研究表明，尽管存在可接受的并发症风险，并且对长期移植功能没有特殊影响，但仍建议移植患者避免妊娠。

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