All concepts, explanations, trials, and studies have been re-written in plain English and may contain errors. I am not a doctor ----------------------------------------------------------- Source: Presse Med 2001 Sep 1;30(24 Pt 2):8-12 Title: Complications in heart transplantation: diagnosis and treatment Author: Bangratz S. PMID: 11577591 ACUTE REJECTION: Heart biopsy is the most reliable way to detect acute rejection. Non-invasive methods have been proposed, including tissular Doppler ultrasonography with analysis of the posterior wall velocity and teletransmitted study of the intramyocardial amplitude of the QRS complex. Adding plasmapheresis to treatment may improve survival and reduce late coronary disease after severe acute reflection. Plasmapheresis also has a preventive effect as do certain inductors such as anti-thrombocyte globulin (ATG). INFECTION: Opportunistic infections are the leading cause of mortality in the year after transplant, generally related to hypogammaglobulinemia. Intravenous immunoglobulins may reduce the frequency of infections. CANCER: More than 1/3 of donor cancers diagnosed after transplant will be transmitted to the heart recipient. Melanoma, choriocarcinoma and renal carcinoma with vascular effraction are the most transferable tumors. DIABETES: Survival at 5 years is lower in heart transplant recipients with diabetes but at 10 years the incidence of CAD and infection are the same. However at 10 years, creatininemia is higher, as is frequency of lower limb arteropathies. RHABDOMYOLYSIS: The incidence of rhabdomyolysis after heart transplant in patients treated with statins is much higher than in the general population. CORONARY ARTERY DISEASE: CAD of the graft is the leading cause of late mortality. Prevention is done through controlling blood pressure and cholesterol levels and using ATG to prevent rejection. GROWTH OF THE GRAFT IN CHILDREN: Growth of the graft has been seen in 17 heart recipients aged less than 13 years at time of transplant. Growth was linear and followed the child's weight and height curves. PREGNANCY: The graft continues to function normally in female heart transplant recipients during pregnancy and post-portum. Studies are needed to determine long-term effect. =================================================================== Source: Minerva Ginecol 1998 Dec;50(12):539-43 Title: Contraception after heart transplantation Authors: Spina V, Aleandri V, Salvi M. It was seen that reduced fertility and menstrual function before transplant in women getting a donor heart become normal with the new heart. Restored reproductive function is also confirmed by cases of pregnancy in heart-transplant recipients. Twenty-four cases were published worldwide up to 1997, out of which 18 had a positive result. Pregnancy after heart transplant involves important maternal and fetal risks, but may be successful. The gynecologist has to provide correct information both about risks and the most suitable contraceptive methods, for these patients. =================================================================== Source: J Heart Lung Transplant 1998 Jul;17(7):698-702 Title: Risks of subsequent pregnancies on mother and newborn in female heart transplant recipients. Authors: Branch KR, Wagoner LE, McGrory CH, Mannion JD, Radomski JS, Moritz MJ, Ohler L, Armenti VT. PMID: 9703235 Female heart transplant recipients can carry pregnancies successfully. We studied the effect of subsequent pregnancies on newborn and maternal outcomes and graft survival. Patients were identified through a previously reported study, a literature review, and recipients entered in the National Transplantation Pregnancy Registry. A retrospective analysis was completed of 35 heart transplant recipients with first pregnancies (FP) and 12 who had one or two additional pregnancies (P>1). Newborns were assessed for premature birth, birth weight, and complications. Maternal data included pregnancy outcome, peripartum complications including infection and rejection, current graft function, and survival. Forty-seven pregnancies (35 FP and 12 P>1) from 35 heart transplant recipients were studied. FP outcomes included 26 live births (one set of twins), four miscarriages, and 6 abortions for medical reasons. P>1 outcomes included 11 live births (one set of twins), and 2 miscarriages. There was no significant difference between average birth weights [2353 gm (P>1) versus 2588 g FP]; or premature birth for the babies who lived. There were more post-birth complications in successive pregnancies (40% versus 12%). Complications were significantly more common in premature newborns compared with full-term newborns. No structural birth defects were seen in the babies who lived. Maternal complication rates were the same in both groups - 40%. Of 28 recipients available for follow-up, the maternal survival rate was 75% for the FP group and 89% for the P> group. Average rejection rate per year was slightly higher after pregnancy in the P>1 group. Those mothers who survived had similar heart function. CONCLUSIONS: Post-heart transplant pregnancies may have successful outcomes, but there is a high rate of pre-birth infant death; and prematurity and low birth weight in surviving babies. Subsequent pregnancies do not seem to significantly increase complications. Larger studies are needed. =================================================================== Source: J Heart Lung Transplant 1997 Aug;16(8):801-12 Title: The incremental risk of female sex in heart transplantation: a multiinstitutional study of peripartum cardiomyopathy and pregnancy. Authors: Johnson MR, Naftel DC, Hobbs RE, Kobashigawa JA, Pitts DE, Levine TB, Tolman D, Bhat G, Kirklin JK, Bourge RC. PMID: 9286772 Controversy remains about why women have higher risk for rejection after heart transplant. This study was done on the effect of a pre-transplant diagnosis of peripartum cardiomyopathy and the effect of previous pregnancy on outcome in females after heart transplant. We studied 3,244 heart transplant recipients older than 13 years. 1) outcome of 40 females who had heart transplant for peripartum cardiomyopathy was compared with that of 200 females who had transplant for other reasons 2) post-transplant outcome of 543 females with a history of pregnancy was compared with that of 101 wonmen who had never given birth and 2,562 men. Post-transplant outcome of peripartum cardiomyopathy patients was similar to that of other women having transplant. However, women who had given birth had a much shorter time to first rejection and greater chronic rejection than men and women who had never given birth. Risk factors for cumulative rejection at one year were a history of pregnancy, younger recipient age, induction therapy, and the number of human leukocyte antigen-DR mismatches. CONCLUSION: It may be previous pregnancy and not sex that is associated with higher rate of rejection in females after heart transplant. =================================================================== Source: Transplantation 1994 Feb 27;57(4):502-6 Title: National transplantation Pregnancy Registry - outcomes of 154 pregnancies in cyclosporine-treated female kidney transplant recipients. Authors: Armenti VT; Ahlswede KM; Ahlswede BA; Jarrell BE; Moritz MJ; Burke JF Outcomes of pregnancies from 115 female kidney transplant recipients maintained on cyclosporine before and during pregnancy were obtained from questionnaires, hospital records, and telephone interviews. Average age of conception was 29 years with an average time after transplant of 2.2 years. There were 156 outcomes including: 1) 2 sets of twins 2) ectopic pregnancies: 1% 3) abortion for medical reasons: 12% 4) miscarriage: 16% 5) stillborn: 2.6% 6) live birth: 68.6% 7) rate of premature birth (birth at less than 37 weeks): 56% 8) low birth weight (under 2500 grams): 49.5% 9) complications occurred in 21.7% of newborns 10) infant death after birth: one Babies who survived averaged birth at 35.6 weeks and averaged 2,407 grams weight at birth. Incidence of drug-treated high blood pressure before pregnancy was 51.7%; of diabetes before pregnancy, 11.7%; of preeclampsia, 24.8%; and of rejection during pregnancy or within 3 months after delivery was 14.5%. Mothers with pregnancy drug-treated high blood pressure had significantly lower birth weight infants (2250g versus 2603g). Mothers with prepregnancy creatinine 1.5 mg/dl or higher had smaller infants (2090g vesus 2505g). Diabetic mothers had lower birth weight infants. Of 107 recipients interviewed, 12 (11%) lost their donor organ, one of them during pregnancy. Eight grafts were lost within 2 years of the pregnancy. For the 8 recipients who lost their graft within 2 years of pregnancy, outcomes included one miscarriage and 7 live births. Five of 8 recipients who had graft loss within 2 years of pregnancy were in the drug-treated high blood pressure group. Prepregnancy factors that increase risk to the baby of a female kidney transplant recipient include maternal drug-treated high blood pressure, diabetes, and blod level of creatinine at 1.5 mg/dl or higher. =================================================================== Source: JeffNEWS, August 1, 1995 Author: Editor, JeffNEWS Title: Jefferson Study Evaluates Impact Of Transplants on Pregnancy Female kidney transplant patients should continue to take immunosuppressive drugs during pregnancy. In fact, they may need increase cyclosporine dose, according to an article in the current issue of the journal Transplantation. We studied 197 pregnancies in 141 female kidney transplant recipients. Of the 197 pregnancies, 137 (68.2%) resulted in live births. The information was was evaluated by Dr. Vincent Armenti, with grant support from Sandoz Pharmaceuticals - a maker of immunosuppressant druugs. Patients in this study became pregnant while being treated with cyclosporine plus other immunosuppressive drugs. These medications were taken throughout pregnancy and during the follow-up period. How does having a transplanted kidney affect the outcome of the pregnancy? Should the dose of cyclosporine be changed during pregnancy? The investigators concluded that: 1) When mothers had well-functioning transplants, the birth weight of surviving babies was higher than the weight of babies born to mothers whose transplants were not functioning as well 2) Complications of pregnancy, such as infection, do affect long- term graft survival 3) During pregnancy, there are changes in metabolism and weight which affect how much cyclosporine is available for the body to use. Pregnant patients who took lower doses of cyclosporine before and during pregnancy had babies with lower birth weight. These patients were more likely to have failure of their transplanted kidney within two years of delivery. "This research indicates that close monitoring and careful dosing can result in a healthy pregnancy and birth," Dr. Armenti said.