Research Article
SOLİD ORGAN TRANSPLANTASYONU SONRASI GEBELİKLERDEN DOĞAN BEBEKLERDEKİ NEONATAL MORBİDİTE VE MORTALİTENİN DEĞERLENDİRİLMESİ
Abstract
Giriş ve Amaç: Bu çalışmada, Başkent Üniversitesi Tıp Fakültesi Ankara Hastanesinde 1993-2016 yılları arasında organ nakli olan ve sonrasında gebelik nedeniyle izlenen annelerin bebeklerinin prenatal, natal ve postnatal izlem verilerinin retrospektif olarak değerlendirilmesi amaçlandı.
Gereç ve Yöntem: Çalışmada 1993-2016 yılları arasında hastanemizde organ nakli yapılan ve organ nakli sonrasında takip edilen reproduktif yaştaki (15-49) 440 kadın hastanın dosyası incelendi. Organ nakli sonrası takip edilen 28 gebe çalışmaya dahil edildi. Maternal (tranplantasyon etiyolojisi, yaşı, nakil yaşı ve gebelik yaşı arasındaki süre, gebelik yaşı, zamanı ve türü, yardımcı üreme tekniği varlığı, gebelik süresince kullanılan ilaçlar ve dozları) ve neonatal (gebelik haftası, doğum ağırlığı, doğum salonu verileri, bebek antropometrik değerleri ile gebelik haftasına göre düşük (SGA), gebelik haftasına göre normal (AGA), gebelik haftasına göre fazla doğum ağırlıklı (LGA) bebek özellikleri ve doğum sonrası yenidoğan yoğun bakım-anne yanı izlem durumu değerlendirildi. İstatistiksel analizler SPSS paket programı kullanılarak yapıldı. Sürekli değişkenler ortalama ± standart sapma (SD) verildi. Kategorik değişkenler sıklık ve yüzdeler ile ifade edildi. Araştırma öncesi etik kurul izni alındı.
Bulgular: Toplam 28 hastaya ait organ naklinin %71,4’ü (20/28) böbrek, %28,6’sı (8/28) karaciğer nakliydi. Organ nakillerinin %60,7’si (17/28) canlı, %39,3’ü (11/28) kadavradan nakildi. En sık görülen transplant etiyolojisi %21,9 ile glomerulonefrit idi. Gebeliklerin %78,6’sı (22/28) canlı doğum, % 21,4’ü (6/28) abortus ile sonuçlanmıştır. Bir kişide akut, iki kişide kronik rejeksiyon gözlenmiştir. En sık kullanılan tedavi protokolü %42,9 ile siklosporin+ prednizolon+ azatiyopurindir. Bebeklerin %40,9’u term, %40,9’u SGA, %59’u pretermdir. Bebeklerin 4’ünde (%18,1) RDS, 3’ünde (%13,6) prematüre retinopatisi (ROP), 1’inde (%4,5) NEK, 3 bebekte konjenital kalp hastalığı saptanmıştır. Bebeklerin %18,2’sinde resüsitasyon ihtiyacı olmuş, %45,4’ ü doğum sonrası anne yanına verilmiştir.
Sonuç: Ülkemizdeki böbrek veya karaciğer nakli olmuş kadınların gebeliklerinden dünyaya gelen yenidoğan bebeklerin takibinde ortaya çıkan perinatal, neonatal morbidite ve mortaliteye ait sonuçların bilinmesi uygun yaklaşım açısından önem taşımaktadır.
Keywords
Supporting Institution
Başkent Üniversitesi Araştırma Fonu tarafından desteklenmiştir.
Project Number
Proje No: KA15/353
References
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- Referans3 Ma KK, Petroff MG, Coscia LA, Armenti VT, Adams Waldorf KM. Complex chimerism: pregnancy after solid organ transplantation. Chimerism. 2013 Jul-Sep;4(3):71-7. doi: 10.4161/chim.25401. Epub 2013 Jun 25.
- Referans4 Watnick S, Rueda J. Reproduction and contraception after kidney transplantation. Curr Opin Obstet Gynecol 2008;20(3):308-12.
- Referans5 Erman Akar M, Ozekinci M, Sanhal C, Kececioglu N, Mendilcioglu I, Senol Y ve ark. A Retrospective Analysis of Pregnancy Outcomes after Kidney Transplantation in a Single Center. Gynecol Obstet Invest. 2015;79(1):13-8. doi: 10.1159/000365815. Epub 2014 Sep 25.
- Referans6 Perales-Puchalt A, Vila Vives JM, Lopez Montes J, Diago Almela VJ, Perales A. Pregnancy outcomes after kidney transplantation-immunosuppressive therapy comparison. J Matern Fetal Neonatal Med. 2012 Aug. 25(8):1363-6.
- Referans7 Framarino dei Malatesta M, Corona LE, De Luca L, Rocca B, Manzia TM, Orlando G, et al. Successful pregnancy in a living-related kidney transplant recipient who received sirolimus throughout the whole gestation. Transplantation 201;91(9):e69-71.
- Referans8 Kato M, Hattori R, Kinukawa T, Kamihira O, Yamada S, Gotoh M: Correlation between treated hypertension in prepregnancy and transplanted kidney function deterioration during pregnancy even if within pregnancy permission criteria. Transplant Proc 2012;44: 635–637.
- Referans9 Deshpande NA, James NT, Kucirka LM, Boyarsky BJ,Garonzik-Wang JM, Montgomery RA, ve ark. Pregnancy outcomes in kidney transplant recipients: a systematic review and meta-analysis. Am J Transplant 2011;11(11):2388-2404.
- Referans10 Parhar KS, Gibson PS, Coffin CS. (2012). Pregnancy following liver transplantation: Review of outcomes and recommendatios for management, Can J Gastroenterol, 26(9); 621-626.
- Referans11 Bramhan K, Nelson-Piercy C, Gao H, Pierce M, Bush N, Spark B, ve ark. (2013). Pregnanacy in renal transplant recipients: A UK National cohort study. Clin J Am Soc Nephrol. 8(2): 290-298.
- Referans12 Westbrook R H, Yeoman AD, Agarwal K, Aluvihare V, O'Grady J, Heaton N ve ark. Outcomes of pregnancy following liver transplantation: The King's College Hospital experience. Liver Transplantation 21.9 (2015): 1153-1159.
- Referans13 T.C. SAĞLIK BAKANLIĞI SAĞLIK İSTATİSTİKLERİ YILLIĞI 2018. Ankara 2019. Sayfa:86. ErişimTarihi: 01.04.2020. https://dosyasb.saglik.gov.tr/Eklenti/36134,siy2018trpdf.pdf?0
- Referans14 Di Loreto P, F. Martino, S. Chiaramonte, D. Dissegna, C. Ronco, D. Marchesoni ve ark. Pregnancy After Kidney Transplantation: Two Transplantation Centers—Vicenza–Udine Experience. Transplantation proceedings. Vol. 42. No. 4. Elsevier, 2010.
- Referans15 Constantinescu S, Pai A, Coscia LA, Davison JM, Moritz MJ, Armenti VT (2014). Breast-feeding after transplantation. Best Practice & Research Clinical Obstetrics & Gynaecology, 28(8), 1163-1173.
- Referans16 Zachariah MS, Tornatore KM, Venuto RC. Kidney transplantation and pregnancy. Curr Opin Organ Transplant 2009;14(4):386-91.
- Referans17 Engle WA, Tomashek KM, Wallman C. Late-Preterm Infants: A Population at risk. Pediatrics 2007;120:1390-401. http://dx.doi.org/10.1542/peds.2007-2952.
- Referans18 Ozkan H., Erdeve O., Kutman G. Türk Neonatoloji Derneği respiratuvar distres sendromu ve surfaktan tedavisi rehberi. Turk Pediatri Ars 2018; 53(Suppl 1): S45-S54.
- Referans19 Dizdar EA, Sari FN, Aydemir C,et al. A randomized, controlled trial of poractant alfa versus beractant in the treatment of preterm infants with respiratory distress syndrome. Am J Perinatol. 2012;29(2):95-100.
- Referans20 Fanaroff AA, Stoll BJ, Wright LL, et al. Trends in neonatal morbidity and mortality for very low birthweight infants. National Instıtute of Child Health and Human Development Neonatal Research Network, January 1997 through December 2002. NICHD Neonatal Research Network. Am J Obstet Gynecol 2007;196:147.e1-147.e8
- Referans21 Dong Y, Speer CP. Late-onset neonatal sepsis: recent developments. Arch Dis Child Fetal Neonatal Ed 2015;100(3):F257-263
- Referans22 Turkish Neonatal S, Nosocomial Infections Study G. Nosocomial infections in neonatal units in Turkey: epidemiology, problems, unit policies and opinions of healthcare workers. Turk J Pediatr 2010;52(1):50-57.
- Referans23 Yapicioglu H, Satar M, Ozcan K, et al. A 6-year prospective surveillance of healthcare- associated infections in a neonatal intensive care unit from southern part of Turkey. J Paediatr Child Health 2010;46(6):337- 342.
- Referans24 Cantey JB, Milstone AM. Bloodstream infections: epidemiology and resistance. Clin Perinatol 2015;42(1):1-16, vii.
- Referans25 Cararach V, Carmona F, Monleon FJ, Andreu J. Pregnancy after renal transplantation: 25 years experience in Spain. Br J Obstet Gynaecol. 1993 Feb. 100(2):122-5.
- Referans26 Tayman C, Tonbul A, Uras N, Kahveci H, Köseoğlu B. Preterm bebeklerde nekrotizan enterokolit için risk faktörlerinin değerlendirilmesi. Güncel Ped. Der. 2011;9:7-13
- Referans27 Good Wv, Hardy RJ, Dobson V, Palmar EA, Phelps DL, Quintos M, Tung B.Early Treatment for Retinopathy of Prematurity Cooperative Group. The incidence and course of retainopathy of prematurity: findings from the early treatment for retinopathy of prematurity study. Pediatrics 2005;116:15-23.
Year 2021,
Volume: 18 Issue: 2, 822 - 827, 01.07.2021
Abstract
Project Number
Proje No: KA15/353
References
- Referans1 Murray JE, Reid DE, Harrison JH, Merrill JP. Successful pregnancies after human renal transplantation. N Engl J Med 1963; 269:341-3; PMID:13936776; http://dx.doi.org/10.1056/NEJM196308152690704
- Referans2 Laifer SA, Guido RS. Reproductive function and outcome of pregnancy after liver transplantation in women. Mayo Clin Proc. 1995 Apr; 70(4): 388- 94.
- Referans3 Ma KK, Petroff MG, Coscia LA, Armenti VT, Adams Waldorf KM. Complex chimerism: pregnancy after solid organ transplantation. Chimerism. 2013 Jul-Sep;4(3):71-7. doi: 10.4161/chim.25401. Epub 2013 Jun 25.
- Referans4 Watnick S, Rueda J. Reproduction and contraception after kidney transplantation. Curr Opin Obstet Gynecol 2008;20(3):308-12.
- Referans5 Erman Akar M, Ozekinci M, Sanhal C, Kececioglu N, Mendilcioglu I, Senol Y ve ark. A Retrospective Analysis of Pregnancy Outcomes after Kidney Transplantation in a Single Center. Gynecol Obstet Invest. 2015;79(1):13-8. doi: 10.1159/000365815. Epub 2014 Sep 25.
- Referans6 Perales-Puchalt A, Vila Vives JM, Lopez Montes J, Diago Almela VJ, Perales A. Pregnancy outcomes after kidney transplantation-immunosuppressive therapy comparison. J Matern Fetal Neonatal Med. 2012 Aug. 25(8):1363-6.
- Referans7 Framarino dei Malatesta M, Corona LE, De Luca L, Rocca B, Manzia TM, Orlando G, et al. Successful pregnancy in a living-related kidney transplant recipient who received sirolimus throughout the whole gestation. Transplantation 201;91(9):e69-71.
- Referans8 Kato M, Hattori R, Kinukawa T, Kamihira O, Yamada S, Gotoh M: Correlation between treated hypertension in prepregnancy and transplanted kidney function deterioration during pregnancy even if within pregnancy permission criteria. Transplant Proc 2012;44: 635–637.
- Referans9 Deshpande NA, James NT, Kucirka LM, Boyarsky BJ,Garonzik-Wang JM, Montgomery RA, ve ark. Pregnancy outcomes in kidney transplant recipients: a systematic review and meta-analysis. Am J Transplant 2011;11(11):2388-2404.
- Referans10 Parhar KS, Gibson PS, Coffin CS. (2012). Pregnancy following liver transplantation: Review of outcomes and recommendatios for management, Can J Gastroenterol, 26(9); 621-626.
- Referans11 Bramhan K, Nelson-Piercy C, Gao H, Pierce M, Bush N, Spark B, ve ark. (2013). Pregnanacy in renal transplant recipients: A UK National cohort study. Clin J Am Soc Nephrol. 8(2): 290-298.
- Referans12 Westbrook R H, Yeoman AD, Agarwal K, Aluvihare V, O'Grady J, Heaton N ve ark. Outcomes of pregnancy following liver transplantation: The King's College Hospital experience. Liver Transplantation 21.9 (2015): 1153-1159.
- Referans13 T.C. SAĞLIK BAKANLIĞI SAĞLIK İSTATİSTİKLERİ YILLIĞI 2018. Ankara 2019. Sayfa:86. ErişimTarihi: 01.04.2020. https://dosyasb.saglik.gov.tr/Eklenti/36134,siy2018trpdf.pdf?0
- Referans14 Di Loreto P, F. Martino, S. Chiaramonte, D. Dissegna, C. Ronco, D. Marchesoni ve ark. Pregnancy After Kidney Transplantation: Two Transplantation Centers—Vicenza–Udine Experience. Transplantation proceedings. Vol. 42. No. 4. Elsevier, 2010.
- Referans15 Constantinescu S, Pai A, Coscia LA, Davison JM, Moritz MJ, Armenti VT (2014). Breast-feeding after transplantation. Best Practice & Research Clinical Obstetrics & Gynaecology, 28(8), 1163-1173.
- Referans16 Zachariah MS, Tornatore KM, Venuto RC. Kidney transplantation and pregnancy. Curr Opin Organ Transplant 2009;14(4):386-91.
- Referans17 Engle WA, Tomashek KM, Wallman C. Late-Preterm Infants: A Population at risk. Pediatrics 2007;120:1390-401. http://dx.doi.org/10.1542/peds.2007-2952.
- Referans18 Ozkan H., Erdeve O., Kutman G. Türk Neonatoloji Derneği respiratuvar distres sendromu ve surfaktan tedavisi rehberi. Turk Pediatri Ars 2018; 53(Suppl 1): S45-S54.
- Referans19 Dizdar EA, Sari FN, Aydemir C,et al. A randomized, controlled trial of poractant alfa versus beractant in the treatment of preterm infants with respiratory distress syndrome. Am J Perinatol. 2012;29(2):95-100.
- Referans20 Fanaroff AA, Stoll BJ, Wright LL, et al. Trends in neonatal morbidity and mortality for very low birthweight infants. National Instıtute of Child Health and Human Development Neonatal Research Network, January 1997 through December 2002. NICHD Neonatal Research Network. Am J Obstet Gynecol 2007;196:147.e1-147.e8
- Referans21 Dong Y, Speer CP. Late-onset neonatal sepsis: recent developments. Arch Dis Child Fetal Neonatal Ed 2015;100(3):F257-263
- Referans22 Turkish Neonatal S, Nosocomial Infections Study G. Nosocomial infections in neonatal units in Turkey: epidemiology, problems, unit policies and opinions of healthcare workers. Turk J Pediatr 2010;52(1):50-57.
- Referans23 Yapicioglu H, Satar M, Ozcan K, et al. A 6-year prospective surveillance of healthcare- associated infections in a neonatal intensive care unit from southern part of Turkey. J Paediatr Child Health 2010;46(6):337- 342.
- Referans24 Cantey JB, Milstone AM. Bloodstream infections: epidemiology and resistance. Clin Perinatol 2015;42(1):1-16, vii.
- Referans25 Cararach V, Carmona F, Monleon FJ, Andreu J. Pregnancy after renal transplantation: 25 years experience in Spain. Br J Obstet Gynaecol. 1993 Feb. 100(2):122-5.
- Referans26 Tayman C, Tonbul A, Uras N, Kahveci H, Köseoğlu B. Preterm bebeklerde nekrotizan enterokolit için risk faktörlerinin değerlendirilmesi. Güncel Ped. Der. 2011;9:7-13
- Referans27 Good Wv, Hardy RJ, Dobson V, Palmar EA, Phelps DL, Quintos M, Tung B.Early Treatment for Retinopathy of Prematurity Cooperative Group. The incidence and course of retainopathy of prematurity: findings from the early treatment for retinopathy of prematurity study. Pediatrics 2005;116:15-23.
There are 27 citations in total.
Details
| Primary Language | Turkish |
|---|---|
| Subjects | Paediatrics |
| Journal Section | Research Articles |
| Authors | |
| Project Number | Proje No: KA15/353 |
| Publication Date | July 1, 2021 |
| Submission Date | June 5, 2020 |
| Acceptance Date | October 31, 2020 |
| Published in Issue | Year 2021 Volume: 18 Issue: 2 |
