Childbearing after liver transplantation.
Childbearing after liver transplantation.
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肝移植后生育。
DOI：
10.1097/00007890-199002000-00018
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发表时间：
1990
期刊：
影响因子：
6.2
通讯作者：
Starzl,TE
中科院分区：
文献类型：
--
作者：
Scantlebury,V;Gordon,R;Tzakis,A;Koneru,B;Bowman,J;Mazzaferro,V;Stevenson,WC;Todo,S;Iwatsuki,S;Starzl,TE
1973年6月至1987年6月行原位肝移植的17例女性患者在移植后5个月至11年内怀孕。孕前和孕期联合应用强的松、环孢素和硫唑嘌呤可维持免疫抑制。1例患者在得知怀孕后停止免疫抑制，仅零星服用硫唑嘌呤。分娩时的平均年龄为26岁。12例患者在肝功能检查中没有改变；7例患者在分娩前表现出轻度或中度的酶升高，1例经皮肝活检证实为排斥反应。与妊娠相关的主要问题是高血压、贫血和高胆红素血症。发生了20例活产(2例分别怀孕2例，1例双胞胎)；13例剖腹产，7例阴道分娩。13例剖腹产中有11例胎龄早产。所有阴道分娩均为足月分娩。妊娠毒血症和胎膜早破是剖宫产的主要指征。没有先天性异常或出生缺陷，所有儿童都存活得很好。在16名一岁以上的儿童中，有15名都有正常的身体和智力发育，有一名儿童表现出不成熟的语言发育。到目前为止，有四个一岁以下的孩子都有正常的里程碑。17名母亲中有16人在移植后2-18年内存活；唯一的死亡病例是淋巴瘤，分别在移植后近4年和分娩后2年半。这一经验表明，接受肝移植的妇女可以安全地生育，尽管早产的风险增加。儿科女性患者的慢性免疫抑制对她们成年后生殖潜能的影响仍有待充分评估，但迄今的结果是有利的。
Seventeen female patients who underwent orthotopic liver transplantation between June 1973 and June 1987 became pregnant 5 months to 11 years after transplantation. Immunosuppression was maintained with combinations of prednisone, cyclosporine, and azathioprine prior to and during pregnancy. One patient discontinued immunosuppression after knowledge of pregnancy, taking only azathioprine sporadically. Mean age at time of delivery was 26 years. Twelve patients had no alteration in liver function studies; 7 patients demonstrated mild or moderate enzyme elevations prior to delivery, with one case of rejection confirmed by percutaneous liver biopsy. Major problems related to pregnancy were hypertension, anemia, and hyperbilirubinemia. Twenty live births occurred (2 patients had 2 separate pregnancies, one patient had a set of twins); 13 were by caesarian section, 7 by vaginal delivery. Eleven of the 13 caesarian births were premature by gestational age. All vaginal births were term. Toxemia of pregnancy and early rupture of membranes were the principal indications for caesarean section. There were no congenital abnormalities or birth defects and all the children are surviving well. Fifteen of 16 children older than one year all have normal physical and mental development, with one child manifesting immature speech development. Four children are under one year, all with normal milestones thus far. Sixteen of the 17 mothers are alive from 2–18 years after transplantation; the only death was from a lymphoma, almost 4 years after transplantation and 2½ years after delivery. This experience suggests that women undergoing liver transplantation can safely bear children despite an increased risk of premature caesarian births. The effect of chronic immunosuppression of female pediatric patients on their reproductive potential later in adulthood remains to be fully evaluated but the results so far are favorable.