The international survey conducted by Barrou and colleagues includes some patients that overlap with the NTPR report (Table 21.2).45,46 Two congenital malformations were reported (bilateral cataract and double aortic arch) and one child developed Type I diabetes at age 3 years.45 There were no structural malformations noted among the offspring of the pancreas-kidney recipients reported to the NTPR. Recipients maintained normoglycemia during pregnancy. Occasional graft losses have occurred in the peripartum period.

Heart, Heart-Lung and Lung

Pregnancies post-heart transplant, with a few cases post-heart-lung transplant, have also been successful.47-50 An international survey by Wagoner et al combined with NTPR data (Branch, Table 21.2) examined the risk of having more than one post-transplant pregnancy and did not find a significant difference in neonatal complications and/or maternal graft survival.50 There were 7 deaths in the first pregnancy group, 3 due to noncompliance, and a single recipient death due to allograft vasculopathy (5.6 yrs post-partum) in the subsequent pregnancy group. No structural malformations were noted in the newborn.

Data are still limited among lung recipients but significant rejection and mortality rates have been noted, prompting concern among practitioners (Table 21.2).51 However, there are a few successful reports to the registry so that it is not possible to make clear-cut recommendations to these recipients with regard to pregnancy safety.

Other Maternal Issues

Maternal infections and other medical complications and their effects on pregnancy have been extensively reviewed.21,36,52-54 Of the infectious complications reported to the registry, most have involved the urinary tract. There are occasional reports to the NTPR and to the literature of CMV infection during pregnancy.36,55,56 A recent single case report described the use of ganciclovir during pregnancy with no untoward effects.56

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