Immunosuppression and Reproductive Health After Kidney Transplantation

Following successful kidney transplantation, recipients usually regain fertility. Post-engraftment pregnancies should be planned and the teratogenic mycophenolic acid should be replaced with azathioprine before conception. To avoid unintentional pregnancies, pre-conception counseling is mandatory in women of reproductive age who are scheduled for a kidney transplant. Counseling should be repeated after transplantation. Female recipients should receive advice to use long-acting reversible contraception and avoid pregnancy for a minimum of 1 year following transplantation. Conception should be deferred even longer in female recipients with moderate to severe proteinuria, uncontrolled hypertension or reduced graft function and be very carefully discussed in highly HLA-sensitized patients. The recipient wishes, values and acceptance of pregnancy-related risk should receive attention. Assisted fertilization increases the risk of pre-eclampsia, but still result in live births. Pregnancy management in kidney transplant recipients should be provided by a multidisciplinary team consisting of a nephrologist, a midwife and an obstetrician with expertise in high-risk pregnancies. Until measurement of unbound fraction of calcineurin inhibitors becomes clinically available, we recommend to adjust calcineurin inhibitor dose according to whole blood trough level, even though it overestimates the effective drug concentration during pregnancy. If nephrotoxicity is suspected, the calcineurin in...
Source: Transplantation - Category: Transplant Surgery Tags: Review Source Type: research

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Conditions:   Apnea, Obstructive Sleep;   Obesity Intervention:   Device: Bioelectrical Impedance Analysis (BIA) Sponsor:   Samuel Lunenfeld Research Institute, Mount Sinai Hospital Recruiting
Source: ClinicalTrials.gov - Category: Research Source Type: clinical trials
Condition:   Cardiotocography Interventions:   Device: Non-Invasive fetal ECG;   Device: Fetal heart rate monitor Sponsors:   Rambam Health Care Campus;   Technion, Israel Institute of Technology Not yet recruiting
Source: ClinicalTrials.gov - Category: Research Source Type: clinical trials
Mothers going through the hurt and trauma of stillbirth need counselors who recognize the true nature of their loss and are willing to sit with them through their pain rather than rushing them to “move on.” The post Understanding stillbirth appeared first on Counseling Today.
Source: Counseling Today - Category: Psychiatry & Psychology Authors: Tags: Counseling Today Member Insights Couples disenfranchised grief pregnancy women Source Type: research
Journal of Women's Health, Ahead of Print.
Source: Journal of Women - Category: OBGYN Authors: Source Type: research
Journal of Women's Health, Ahead of Print.
Source: Journal of Women - Category: OBGYN Authors: Source Type: research
Source: BMJ - Category: General Medicine Source Type: research
ConclusionsWith regard to KT patients and sterile wound dressing fixation with non-sterile bandages versus the use of autoclaved bandages, fixation with autoclaved bandages proved to be effective for cutaneous mucormycosis outbreak control and prevention in our institution.
Source: American Journal of Infection Control - Category: Infectious Diseases Source Type: research
Purpose of review Outline some regulatory considerations and scientific challenges related to the development of long-acting antiretrovirals (ARVs) for the treatment and prevention of HIV-1 infection. Recent findings Poor adherence to oral ARV regimens continues to pose challenges for effective treatment and prevention of HIV-1 infection. The development of long-acting ARV modalities for treatment and prevention of HIV-1 infection is emerging as a promising alternative to the current treatment and prevention paradigm and has gained considerable interest. Summary The development of long-acting ARVs can present some ...
Source: Current Opinion in HIV and AIDS - Category: Infectious Diseases Tags: LONG ACTING ART FOR TREATMENT AND PREVENTION: Edited by Martin Markowitz Source Type: research
CONCLUSIONS In middle-aged and elderly individuals without CKD, arterial stiffness determined by obesity, dyslipidemia and increased pulse pressure, was significantly associated with increased serum levels of cystatin C. PMID: 31793519 [PubMed - in process]
Source: Medical Science Monitor - Category: Research Tags: Med Sci Monit Source Type: research
AbstractPurpose of ReviewTo review the studies and practice guidelines on the preeclampsia risks in kidney donors and recipients.Recent FindingsThere is a small increased risk of gestational hypertension and preeclampsia in pregnancies that follow kidney donation. Kidney Disease Improving Global Outcomes (KDIGO) Clinical Practice Guideline (2017) and the 2015 American Society of Transplantation (AST) consensus conference statement recommends counseling kidney donors about this increased risk. There is no observed increase in fetal complications or eclampsia post-kidney donation. Preeclampsia is more commonly observed in ki...
Source: Current Hypertension Reports - Category: Primary Care Source Type: research
More News: Breastfed | Children | Hypertension | Kidney Transplant | Kidney Transplantation | Midwifery | OBGYN | Pre-eclampsia | Pregnancy | Proteinuria | Reproduction Medicine | Transplant Surgery | Transplants | Urology & Nephrology | Women