Solid Organ transplantation Flashcards
What are the factors complicating pregnancy in transplantation patients
- Preeclmapsia
- GDM
- Graft dysfunction
- Fetal growth restriction
- Preterm delivery
Prevelnace of renal transplant in UK in child bearing age
2-6 / 10000 women
percent of transplant patients get pregnant anually
30-40 pregnancies per year
Conception after renal transplant
Conception is not advised within the first year following renal transplantation when doses of immunosuppressants are higher and graft stability is more difficult to assess.
how we do pre pregnancy counselling in renal transplant patients
- Teratogenic meds (ACEI - Mycophenolate - ARB - Warfarin) should be discontinued before preg.
- pregnancy planned after 1 year of transplantation
Complaications. that we encounter in transplant patients during pregnancy
- if not taking anti HTN–> needs med. during pregnancy
- Superimposed PE
- Proteinuria >1g/day leads to loss of renal function
- Tacrolimus and prednisone are diabetogenic so high risk for GDM
Effects of renal transplant on pregnancy
High creatinine assay with poor outcome like:
* Pregnancy loss
* Perinatal death
* HTN
* PE
* Growth restriction
What si the acute rejection rate in pregnancy
4.2%
If there is a rise in creatinine in transplant patients, what is the cause?
Preeclampsia
if graft rejection is suspected during pregnancy, what to do?
- Optimization of immunosuppresive drugs
- Monitoring Cyclosporin, tacrolimus levels in blood
- Treat DM & HTN
Babies exposed to biological agents in neonatal period, which vaccine should avoid?
Live vaccines
1. BCG
2. MMR
3. VZV
4. Typhoid
5. Oral Polio
6. Yellow Fever
During 1st 6 months of life
Where antenatal care should be given
Multidiciplinery team
(consultant let with transplant surgeon)
Antenatal tests should be carried out with pt. of transplant
- Midstream Urine for culture
- Urine for Proteinuria
- Protein Creatinine ratio or Albumin Creat. ratio
- RFT - LFT in PE
- OGTT
- CBC for anemia or thrombocytopenia
- 12 & 20 Weeks Scan
- 1st trimester anomaly screening: double marker
Factors cause proteinuria
- Pre-existing HTN
- Super emposed PE
- ACEI - ARB
Effects o proteinuria on patients with transplant
- Hypercoagulability
- Inc. risk of venous thromboembolism