肾移植术后妊娠对移植肾的影响

Influence of pregnancy on graft after renal transplantation

目的 探讨肾移植术后妊娠对移植肾的影响。方法 对 1 978年 4月至 2 0 0 2年 3月妊娠超过 5个月的 1 3例肾移植受者资料进行回顾性分析。结果 免疫抑制方案 ,4例采用环孢素A(CsA)及泼尼松 (Pred) ,5例为CsA、霉酚酸酯 (MMF)及Pred ,4例为他克莫司 (FK50 6)、MMF及Pred。 1 3例中 ,1 0例患者妊娠足月、生产 ,母、婴均存活 ,移植肾功能稳定 ;1例产后 2周因并发肺部感染、心力衰竭死亡 ,死亡时移植肾有功能 ,婴儿存活 ;2例妊娠中期出现蛋白尿 ,病理证实移植肾发生慢性排斥反应 ,终止妊娠 ,但抗排斥治疗无效 ,切除移植肾 ,恢复血液透析。目前 1 1名子女健康 ,无发育异常。结论 肾移植患者若情况允许 。

Objective To investigate the influence of pregnancy on graft after renal transplantation. Methods Clinic data from 13 female transplant recipients with pregnant duration more than 5 months from May 1978 to March 2002 were retrospectively analyzed. Results Immunosuppressive programs: 4 patients received CsA plus Pred, 5 CsA, MMF plus Pred, and 4 FK506, MMF plus Pred. Among the 13 cases, 10 had successful pregnancies with stable graft function; one died of pulmonary infection and cardiac insufficiency with functioning graft after delivery (the baby was safe); 2 experienced chronic rejection proven by biopsy, getting graft lost and pregnancy terminated: one returned to hemodialysis till now and one received successful retransplantation after 1 year hemodialysis. 11 offerings are healthy by now.Conclusion Patient/kidney survival in our study was 76.9?% . Our data and literature have demonstrated that pregnancy has no effect on graft long term survival or function. It is advisable in a woman of childbearing age with a well functioning renal graft 2 years after transplantation, but must be considered risk. Chronic rejection is a risk factor for graft loss following pregnancy. FK506,CsA and MMF have no side effect on newborns.