Management and Perspectives of Pregnancies in Solid Organ Transplant Recipients

Abstract

Advances in immunosuppressant drugs and surgical techniques enabled pregnancies in numerous women who suffer of end-stage organ disfunction worldwide. Better tolerance to allogenic grafts, and ameliorated risk of drug toxicity created a possibility of both successful reproduction and preservation of a long-time function of a transplanted organ. 75%of pregnancies in transplant patients are registered among renal transplant recipients, followed by liver and heart transplant, all of them connected into a group of solid organ transplants (SOT). Increasing number of pregnancies emerge also from the group of patients with combined  simultaneous renal-pancreatic transplant (RPT), due to treatment of an end-stage organ disfunction of  diabetes mellitus Type 1, and a lung transplant, due to terminal stage of cystic fibrosis. All transplant recipints have an increased risk of miscarriage, preterm birth and fetal malformations. Renal and RPT recipients are in enhanced risk of hypertensive disorders and preeclampsia. All the immunosuppressant drugs pass the fetoplacental barrier, and pose a certain risk for embryonal and fetal development. There is no absolute safe immunosuppressant. Pregnancies of  women with solid organ transplantations are high-risk pregnancies, with certain peculiarities for each of  different transplanted organs. These pregnancies have to be closly monitored and supervised by multidisciplinary teams consisted of transplant medicine specialists, surgeons, maternal-fetal medicine subspecialists and neonatologists. Furthermore, SOT open a new winodow of ethical concerns due to reduced maternal lifespan and different moral dilemmas connected with support of their ofspring.