Pregnancy after kidney and liver transplantation

Authors

  • A Wise Department of Obstetrics and Gynaecology, Rahima Moosa Mother and Child Hospital and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa https://orcid.org/0000-0001-5182-9060
  • N E Diana Division of Nephrology, Department of Internal Medicine, Charlotte Maxeke Johannesburg Academic Hospital and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa https://orcid.org/0000-0001-6461-8609
  • B Bobat Department of Gastroenterology and Hepatology, Wits Donald Gordon Medical Centre, Johannesburg, South Africa https://orcid.org/0000-0001-7575-397X
  • R T Saggers Department of Paediatrics and Child Health, Charlotte Maxeke Johannesburg Academic Hospital and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa https://orcid.org/0000-0001-6593-8049
  • S Bhoora Division of Maternal Critical Care, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas, USA; Department of Obstetrics and Gynaecology, Charlotte Maxeke Johannesburg Academic Hospital and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa https://orcid.org/0000-0003-1804-2690
  • S Budhram Department of Obstetrics and Gynaecology, Tygerberg Hospital and Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa https://orcid.org/0000-0002-5747-1714
  • L Chauke Department of Obstetrics and Gynaecology, Charlotte Maxeke Johannesburg Academic Hospital and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa https://orcid.org/0000-0001-7051-6959
  • V G Lala Department of Gastroenterology and Hepatology, Wits Donald Gordon Medical Centre, Johannesburg, South Africa; Division of Medical Gastroenterology, Department of Internal Medicine, Charlotte Maxeke Johannesburg Academic Hospital and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa https://orcid.org/0000-0003-2543-7025
  • A Mahomed Division of Medical Gastroenterology, Department of Internal Medicine, Charlotte Maxeke Johannesburg Academic Hospital and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa https://orcid.org/0000-0002-0560-014X
  • D Mokgoko Division of Medical Gastroenterology, Department of Internal Medicine, Charlotte Maxeke Johannesburg Academic Hospital and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa https://orcid.org/0000-0002-2413-739X
  • M Seabi Division of Medical Gastroenterology, Department of Internal Medicine, Charlotte Maxeke Johannesburg Academic Hospital and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa https://orcid.org/0000-0002-7841-6466
  • B Moore Private Practice, Netcare Park Lane Hospital, Johannesburg, South Africa https://orcid.org/0009-0007-1224-7552
  • S Naidoo Division of Nephrology, Department of Internal Medicine, Charlotte Maxeke Johannesburg Academic Hospital and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa https://orcid.org/0000-0001-5878-0247
  • R B Nyakoe Department of Obstetrics and Gynaecology, Charlotte Maxeke Johannesburg Academic Hospital and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa https://orcid.org/0000-0002-2618-3111
  • N Odell Department of Obstetrics and Gynaecology, Charlotte Maxeke Johannesburg Academic Hospital and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa https://orcid.org/0009-0006-7545-5175
  • G Paget Division of Nephrology, Department of Internal Medicine, Charlotte Maxeke Johannesburg Academic Hospital and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa https://orcid.org/0000-0002-8274-1157
  • L Wium Women’s Services, King’s College Hospital, London, UK https://orcid.org/0000-0001-7949-7651
  • J Zamparini Obstetric Internal Medicine Unit, Department of Internal Medicine, Charlotte Maxeke Johannesburg Academic Hospital and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa https://orcid.org/0000-0002-1365-5650

DOI:

https://doi.org/10.7196/SAMJ.2024.v114i3b.1240

Keywords:

Pregnancy, liver transplant, kidney transplant, high-risk obstetrics

Abstract

Pregnancy in kidney and liver transplant recipients presents unique challenges and risks for both maternal and fetal health. This article examines the management of pregnancy in kidney and liver transplant recipients, focusing on pre-pregnancy counselling, trimester-specific care, the teratogenic effects of immunosuppressive drugs, and the role of the multidisciplinary team. While South African (SA) data on this topic are limited, the Transplant Pregnancy Registry International has provided valuable insights. Despite the increased risk of maternal and fetal complications, the overall risk of graft loss during pregnancy is low. Graft survival rates are comparable between pregnant and non- pregnant transplant recipients, except for pregnancies occurring within 1 year of transplantation. By addressing the complexities of managing pregnant women with kidney or liver transplants, this article underscores the importance of tailored care and the involvement of various medical specialists. It also explores the safety of and potential complications associated with specific immunosuppressive therapies during pregnancy. Further research is needed to enhance our understanding and optimise the management of these high-risk pregnancies in SA.

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2024-04-24

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Supplement: Transplantation in SA

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1.
Wise A, Diana NE, Bobat B, Saggers RT, Bhoora S, Budhram S, et al. Pregnancy after kidney and liver transplantation. S Afr Med J [Internet]. 2024 Apr. 24 [cited 2025 Mar. 23];114(3b):e1240. Available from: https://samajournals.co.za/index.php/samj/article/view/1240

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