肾移植后IVF妊娠:临床病例及文献复习

E. Prokopenko, V. Guryeva, V. Petrukhin, K. Krasnopol’skaya, F. Burumkulova, D. V. Gubina
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摘要

肾移植(KT)是5期慢性肾脏疾病(CKD)的最佳治疗方法,可恢复大多数育龄妇女受损的生育能力。然而,一些患者在KT成功后出现不孕症。我们提出了自己的经验,克服继发性输卵管性不孕症的体外受精(IVF)。患者是一名36岁的肾脏移植患者,由于严重的先兆子痫(PE),她曾两次流产。在激素替代疗法的背景下,第二次尝试冷冻解冻胚胎移植后,一个胚胎被移植到子宫内,导致怀孕。妊娠期糖尿病(GDM)在妊娠早期被诊断出来,并规定了饮食。妊娠期间给予他克莫司、硫唑嘌呤和甲基强的松龙免疫抑制,低分子肝素和抗血小板药物预防PE。37-38周择期剖宫产,生下一名健康男婴,体重2760 g(第25百分位),身高48 cm(第36百分位)。不需要在新生儿重症监护病房住院。婴儿生长发育正常,母亲移植肾功能满意。因此,试管婴儿可以成功地用于kt后不孕不育患者,只要试管婴儿计划得到仔细控制,并以多学科方式管理妊娠。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
IVF pregnancy after kidney transplantation: clinical case and literature review
Kidney transplantation (KT), the optimal treatment for stage 5 chronic kidney disease (CKD), restores impaired fertility in most women of reproductive age. However, infertility occurs in some patients after successful KT. We present our own experience of overcoming secondary tubal infertility by in vitro fertilization (IVF). The patient was a 36-year-old with a transplanted kidney, who had lost two pregnancies in the past due to severe preeclampsia (PE). After the second attempt on cryo-thawed embryo transfer against the background of hormone replacement therapy, one embryo was transferred into the uterus, resulting in pregnancy. Gestational diabetes mellitus (GDM) was diagnosed in the first trimester, and a diet was prescribed. Immunosuppression with tacrolimus, azathioprine and methylprednisolone, prophylaxis of PE with low molecular weight heparin and antiplatelet drugs were administered during pregnancy. Elective cesarean section was performed at 37–38 weeks and a healthy boy was born, weighing 2760 g (25th percentile), 48 cm tall (36th percentile). A stay in the neonatal intensive care unit was not required. The baby is growing and developing normally, the mother’s renal graft function is satisfactory. So, IVF can be successfully used in post-KT patients with infertility issues, provided that the IVF program is carefully controlled, and the pregnancy is managed in a multidisciplinary manner.
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