Pregnancy Following Transplantation

Dear Sir We have read the article “Risk of Obstetrical Complications in Organ Transplant Recipient Pregnancies” by Brosens et al. (1) with great interest. A review of the history of solid-organ transplantation pregnancies reveals that more than 14,000 women have given birth after transplantation since 1954 (2). Although pregnancy after transplantation is considered high risk, it has now been considered reasonable in certain circumstances (1). The present data show that primary maternal and fetal complications in the renal transplant recipient are anemia, proteinuria, infection, low birthweight, miscarriage, preeclampsia, hypertension, preterm labor, premature rupture of the membranes, and acute organ rejection (3). Collaboration of the perinatologist and transplant physicians before, during, and after pregnancy and close monitoring of the recipient is mandatory for better pregnancy and graft outcome. Recommended time interval between transplantation surgery and conception should be at least 12 months and individualized according to the general health of the patient, maintenance presence of stable immunosuppressive levels, stable graft function, and fertility potential of the patient (3). We agree that defective deep placentation (DDP) might be responsible for some of the associated pregnancy complications such as preeclampsia, intrauterine growth restriction, and late spontaneous abortion in transplant recipients. In our uterus transplantation case, we have observed restricted development of the gestational sac compared with the embryo development (4). Retarded gestational sac might also be an important sign of DDP. Diagnosis and treatment of DDP is difficult requiring further data. We would also like to correct the information that the first human transplantation report in 2000 was not performed by our group cited as reference 61 in the article. We were the team who performed the first uterus transplantation from a deceased donor in 2011 leading to the first reported clinical pregnancy (4). Further collection and report of detailed patient databases will provide us the information needed for decreasing the transplantation-related morbidity and mortality in this high-risk group of patients.