Transplantation proceedings · 2018
A Nationwide Study on Outcomes for the Offspring of Renal Transplant Recipients in Taiwan.
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Lin C-H, Chang S-N, Chen C-H
Аннотация
OBJECTIVE: Hormonal changes, in either men or women experiencing chronic kidney disease, cause decreased libido, erectile dysfunction, dysmenorrhea, and ovarian dysfunction, all of which may contribute to infertility. Patients' endocrinal and sexual function could be rapidly restored after successful renal transplantation (RTx), which may assist in achieving a successful pregnancy. However, fetuses will be exposed to the immunosuppressive agents passed on from the female recipients, which may be another potential factor leading to a poor fetal outcome. This nationwide study examined the perinatal status of offspring from RTx recipients in Taiwan.
METHODS: The National Health Insurance (NHI) program is a mandatory universal health insurance program in Taiwan which provides coverage for 99.6% of its population. Nationwide, births totaled 2,562,253 between 2001 and 2012. Of that total, 97 births were from mothers who had had a RTx prior to delivery. A total of 2,561,973 births from the general population was then determined by combining the NHI database with the National Birth Registry database. Offspring from the RTx recipients and the general population was at a ratio of 1:10 matched by both birth year and birth month, where 77 offspring were from RTx recipients, while 770 served as a control.
RESULTS: The offspring from the RTx group displayed significant statistical differences from the general population regarding low birth weight (< 2500 g) (53.3% vs 9.9%, P < .001), premature delivery (< 37 weeks) (46.8% vs 10.7%, P < .001), and high cesarean section delivery rate (50.7% vs 38.2%, P = .033). Regarding the Apgar score, which was assessed 1 minute and 5 minutes after each birth, fewer than 7 disclosed rates of 21.3% and 6.7% respectively in offspring of the RTx group; the corresponding numbers were 5.1% (P < .001) and 2.3% (P = .028) respectively in the other group.
CONCLUSION: Upon restoration of fertility after RTx, most female recipients wish to have their own child; therefore, we as doctors have the responsibility to provide the necessary information we possess regarding the outcomes of offspring of female surgery recipients of childbearing age. Consequently, as the outcomes may not be satisfactory, we will continue to require more studies on the long-term outcome of offspring from RTx recipients in order to provide a more rational conclusion.
METHODS: The National Health Insurance (NHI) program is a mandatory universal health insurance program in Taiwan which provides coverage for 99.6% of its population. Nationwide, births totaled 2,562,253 between 2001 and 2012. Of that total, 97 births were from mothers who had had a RTx prior to delivery. A total of 2,561,973 births from the general population was then determined by combining the NHI database with the National Birth Registry database. Offspring from the RTx recipients and the general population was at a ratio of 1:10 matched by both birth year and birth month, where 77 offspring were from RTx recipients, while 770 served as a control.
RESULTS: The offspring from the RTx group displayed significant statistical differences from the general population regarding low birth weight (< 2500 g) (53.3% vs 9.9%, P < .001), premature delivery (< 37 weeks) (46.8% vs 10.7%, P < .001), and high cesarean section delivery rate (50.7% vs 38.2%, P = .033). Regarding the Apgar score, which was assessed 1 minute and 5 minutes after each birth, fewer than 7 disclosed rates of 21.3% and 6.7% respectively in offspring of the RTx group; the corresponding numbers were 5.1% (P < .001) and 2.3% (P = .028) respectively in the other group.
CONCLUSION: Upon restoration of fertility after RTx, most female recipients wish to have their own child; therefore, we as doctors have the responsibility to provide the necessary information we possess regarding the outcomes of offspring of female surgery recipients of childbearing age. Consequently, as the outcomes may not be satisfactory, we will continue to require more studies on the long-term outcome of offspring from RTx recipients in order to provide a more rational conclusion.