Habli M, Belal D, Sharma A, Halawa A. Infertility, pregnancy and breastfeeding in kidney transplantation recipients: Key issues. World J Meta-Anal 2023; 11(3): 55-67 [DOI: 10.13105/wjma.v11.i3.55]
Corresponding Author of This Article
Ahmed Halawa, FRCS, FRCS (Gen Surg), MSc, Associate Professor, Department of Transplantation, Sheffield Teaching Hospitals, Glossop Road, B6069, Sheffield S10 2JF, United Kingdom. ahmed.halawa@worldkidneyacademy.org
Research Domain of This Article
Transplantation
Article-Type of This Article
Review
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Meta-Anal. Mar 2, 2023; 11(3): 55-67 Published online Mar 2, 2023. doi: 10.13105/wjma.v11.i3.55
Infertility, pregnancy and breastfeeding in kidney transplantation recipients: Key issues
Mohamad Habli, Dawlat Belal, Ajay Sharma, Ahmed Halawa
Mohamad Habli, Department of Internal Medicine, Division of Nephrology, Kingdom Hospital, Riyadh 11564, Saudi Arabia
Dawlat Belal, Kasr El-Ainy School of Medicine, Cairo University, Cairo 11562, Egypt
Ajay Sharma, Royal Liverpool University Hospital, Royal Liverpool University Hospital, Liverpool L7 8YE, United Kingdom
Ahmed Halawa, Department of Transplantation, Sheffield Teaching Hospitals, Sheffield S10 2JF, United Kingdom
Author contributions: All authors contributed equally.
Conflict-of-interest statement: No conflict of interest.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ahmed Halawa, FRCS, FRCS (Gen Surg), MSc, Associate Professor, Department of Transplantation, Sheffield Teaching Hospitals, Glossop Road, B6069, Sheffield S10 2JF, United Kingdom. ahmed.halawa@worldkidneyacademy.org
Received: December 31, 2022 Peer-review started: December 31, 2022 First decision: January 20, 2023 Revised: January 22, 2023 Accepted: February 13, 2023 Article in press: February 13, 2023 Published online: March 2, 2023 Processing time: 59 Days and 20 Hours
Abstract
Chronic kidney disease (CKD), especially in advanced stages, is an important cause of infertility. In CKD patients, infertility has been linked to multiple factors. The pathophysiology of infertility related to CKD is complex and forked. Correction of modifiable factors can improve fertility in both genders. In males as well as females, successful kidney transplantation offers good chances of restoration of reproductive function. In female renal allograft recipients, recovery of reproductive functions in the post-transplant period will manifest as restoration of normal menses and ovulation. Owing to this improvement, there is a significant risk of unplanned pregnancy, hence the need to discuss methods of contraception before transplantation. In kidney transplant recipients, different contraceptive options for pregnancy planning, have been used. The selection of one contraception over another is based on preference and tolerability. Pregnancy, in renal transplanted females, is associated with physiologic changes that occur in pregnant women with native kidneys. Immunosuppressive medications during pregnancy, in a recipient with a single functioning kidney, expose the mother and fetus to unwanted complications. Some immunosuppressive drugs are contraindicated during pregnancy. Immunosuppressive medications should be discussed with renal transplant recipients who are planning to breastfeed their babies. In addition to antirejection drugs, other medications should be managed accordingly, whenever pregnancy is planned.
Core Tip: Chronic kidney disease (CKD) is a major cause of infertility in both sexes. Multiple factors amplify infertility in CKD patients. Kidney transplantation can restore fertility in men and women. Menses will return in the majority of females after kidney transplantation. This improvement increases the risk of accidental pregnancy, so contraception should be discussed in advance. Kidney transplant recipients utilize several contraceptives to plan pregnancy. Preference and tolerability determine contraception choice. If pregnancy occurs, transplanted women experience the same physiologic changes as pregnant women with native kidneys. During pregnancy, immunosuppressive drugs can cause consequences. Breastfeeding kidney transplant recipients should discuss immunosuppressive and other medicines.
