肾移植术后妊娠4例次报告并文献复习  

Pregnancy after renal transplantation: 4 cases report and literature review

作　　者：韩志友[1] 吴振起[1] 吴雅冰[1] 马雪涛[1] 

机构地区：[1]北京中医药大学东直门医院泌尿外科,100700

出　　处：《器官移植》2011年第4期201-204,共4页Organ Transplantation

摘　　要：目的探讨肾移植术后妊娠对肾移植患者及胎儿的影响以及妊娠后免疫抑制药物的合理应用。方法回顾分析4例次肾移植术后妊娠的临床资料并复习相关文献。结果 3例女性患者均接受同种异体肾移植术,术后妊娠4例次,1次因移植肾失功人工引产,二次肾移植后再次妊娠。移植术后至妊娠前2例患者应用环孢素（CsA）＋麦考酚吗乙酯（MMF）＋泼尼松三联免疫抑制方案,1例采用他克莫司（FK506）＋MMF＋泼尼松三联免疫抑制方案。计划妊娠前FK506转换成CsA、MMF转换成硫唑嘌呤,分娩后重新恢复原三联免疫抑制方案。妊娠期间,前3个月每2周检测生化指标、血药浓度;妊娠6个月后每周监测生化指标、每2周监测血药浓度。患者分别在孕30周、32周、35周时因先兆子或胎儿宫内窘迫行剖宫产,各娩出1名女婴。随访2~7年,平均48个月,患者及婴幼儿均健康。结论功能正常的移植肾能够承受妊娠带来的生理变化,但胎儿风险因素较多,应视为高危妊娠。移植患者应在计划妊娠前更换合理的免疫抑制方案,妊娠期密切监测药物浓度,精确调整免疫抑制剂剂量,使其血药浓度始终保持在治疗窗内,这样有助于患者顺利妊娠并成功分娩。Objective To investigate the influence of pregnancy on renal transplant recipients and fetus after renal transplantation,and the reasonable application of immunosuppressant after pregnancy in renal transplantation recipients.Methods Clinical data of 4 cases of pregnancy after renal transplantation were retrospectively analyzed and the related literatures were reviewed.Results Three female recipients underwent allogene renal transplantation and had 4 pregnancies after transplantation.One of them had to undergo induced labour because of renal allograft failure and had pregnancy again after second renal transplantation.From post-transplantation to pre-pregnancy,the triple immunosuppressive regimen,including ciclosporin（CsA）,mycophenolate mofetil（MMF）,and prednisone,were used in 2 patients and another triple regimen consist of tacrolimus（FK506）,MMF and prednisone was used in the other patient.The regimen was changed from FK506 plus MMF to CsA plus azathioprine before pregnancy planning.The regimen was returned to primary immunosuppressant after childbirth.During the first 3 months of pregnancy,biochemical indicators and blood concentration of immunosuppressant were measured every 2 weeks.During the last 3 months of pregnancy,biochemical indicators were detected every week and blood concentration was detected every 2 weeks.Caesarean were respectively performed at gestational 30,32,35 weeks because of pre-eclampsia or fetal distress.Each patient gave birth to a baby girl.All the patients were followed up for 2-7 years（average 48 months）.Both the patients and babies were in good health.Conclusions Renal allograft with normal function can withstand the physiological changes of pregnancy.However,there are many risk factors for fetus,and the pregnancy after renal transplantation should be considered as high risk pregnancy.Appropriate change of the immunosuppressive regimen should be carefully considered and made before pregnancy planning.Monitoring blood concentration carefully and adjusting the immunosuppr

关 键 词：肾移植 妊娠 分娩 免疫抑制治疗 

分 类 号：R699.2[医药卫生—泌尿科学]