Solid Organ transplantation

Question 1

What are the factors complicating pregnancy in transplantation patients

Answer 1

• Preeclmapsia
• GDM
• Graft dysfunction
• Fetal growth restriction
• Preterm delivery

Question 2

Prevelnace of renal transplant in UK in child bearing age

Answer 2

2-6 / 10000 women

Question 3

percent of transplant patients get pregnant anually

Answer 3

30-40 pregnancies per year

Question 4

Conception after renal transplant

Answer 4

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.

Question 5

how we do pre pregnancy counselling in renal transplant patients

Answer 5

1. Teratogenic meds (ACEI - Mycophenolate - ARB - Warfarin) should be discontinued before preg.
2. pregnancy planned after 1 year of transplantation

Question 6

Complaications. that we encounter in transplant patients during pregnancy

Answer 6

• 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

Question 7

Effects of renal transplant on pregnancy

Answer 7

High creatinine assay with poor outcome like:
* Pregnancy loss
* Perinatal death
* HTN
* PE
* Growth restriction

Question 8

What si the acute rejection rate in pregnancy

Answer 8

4.2%

Question 9

If there is a rise in creatinine in transplant patients, what is the cause?

Answer 9

Preeclampsia

Question 10

if graft rejection is suspected during pregnancy, what to do?

Answer 10

• Optimization of immunosuppresive drugs
• Monitoring Cyclosporin, tacrolimus levels in blood
• Treat DM & HTN

Question 11

Babies exposed to biological agents in neonatal period, which vaccine should avoid?

Answer 11

Live vaccines
1. BCG
2. MMR
3. VZV
4. Typhoid
5. Oral Polio
6. Yellow Fever

During 1st 6 months of life

Question 12

Where antenatal care should be given

Answer 12

Multidiciplinery team
(consultant let with transplant surgeon)

Question 13

Antenatal tests should be carried out with pt. of transplant

Answer 13

• 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

Question 14

Factors cause proteinuria

Answer 14

• Pre-existing HTN
• Super emposed PE
• ACEI - ARB

Question 15

Effects o proteinuria on patients with transplant

Answer 15

1. Hypercoagulability
2. Inc. risk of venous thromboembolism

Question 16

When we can give prophylaxis LMWH in transplant pt.?

Answer 16

• Generalized edema
• Thromboembolism
• when P/C ratio >300 mg/dl
• or Alb./C ratio >180 mg/dl

Question 17

In transplant pt., how often RFT should be done during pregnancy?

Answer 17

Monthly

Inc. depending on previous RFTs & clinical picture