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PARENTHOOD FOLLOWING RENAL AND HEPATIC TRANSPLANTATION

Our extensive experience with parenthood following transplantation includes 67 pregnancies caused by 50 male renal recipients, 56 pregnancies in 37 female renal recipients, and 3 pregnancies in female hepatic recipients. There were 109 live births, 1 stillbirth, 11 abortions (3 spontaneous), 1 ectopic pregnancy, and 5 pregnancies are still current. Major risks to pregnant female renal recipients include a 27% incidence of preeclampsia and a 7% chance of permanent impairment of renal functions. Patients with hypertension and/or impaired renal function before pregnancy are particularly prone to these complications. In patients with satisfactory renal function before pregnancy, there may be some deterioration during gestation. Usually this is transient and returns to preexisting levels postpartum. Usually the transplanted kidney does not produce any mechanical dystocia during labor. During vaginal delivery there is no apparent mechanical injury to the transplanted kidney. Severe postpartum sepsis may occur. Risks to the offspring of male renal recipients are small. However, there is a substantial hazard to the newborn of female recipients. Forty-nine percent of the newborns were delivered prematurely. Thirty percent had one or more complications during the neonatal period including respiratory distress syndrome, congenital anomalies, adrenocortical insufficiency, infection, hyperviscosity, liver dysfunction, and seizures. Experience of parenthood after liver transplantation is limited to two females, both with good hepatic function. One had two satisfactory pregnancies and gave birth to normal infants. The second underwent therapeutic abortion as parenthood was not desired. Both women continued with good homograft function.