以质量求发展，以服务铸品牌

Journal of Nursing ›› 2025, Vol. 32 ›› Issue (6): 32-37.doi: 10.16460/j.issn1008-9969.2025.06.032

Previous Articles     Next Articles

Best evidence summary for pregnancy management in renal transplant recipients

ZHAO Wenjinga, GUAN Xiaohonga, ZHANG Hailingb, YU Juana, CHU Aiqinb, GE Wenjinga, SHI Kea   

  1. a. Dept. of Renal Transplantation; b. Dept. of Nursing Administration, the First Affiliated Hospital of University of Science and Technology of China, Anhui Provincial Hospital, Hefei 230001, China
  • Received:2024-10-11 Online:2025-03-25 Published:2025-05-06

PDF (PC)

0

Like

Abstract: Objective To summarize the evidence related to pregnancy management in renal transplant recipients. Methods Evidence-based questions on pregnancy management in renal transplant recipients were constructed according to the PIPOST model. The evidence on pregnancy management in renal transplant recipients was systematically searched in accordance with the "6S" pyramid in guideline networks, association websites, and databases at home and abroad. The retrieval period spanned from the inception to January 30, 2024. Literature quality assessment and summarization of the evidence were performed by two researchers. Results A total of 15 papers were included, including 1 clinical decision, 5 guidelines, 5 expert consensus and 4 systematic evaluations, and 31 pieces of evidence were summarized into 7 areas: team formation, contraceptive management, timing of pregnancy, medication management during pregnancy, medication management during lactation, follow-up management during pregnancy, and timing of delivery. Conclusion This study systematically summarizes the evidence related to pregnancy management in renal transplant recipients based on evidence-based method, with the aim of effectively guiding renal transplant recipients to avoid pregnancy-related risks, improve maternal and infant outcomes, and safeguard maternal and child safety.

Key words: kidney transplantation, pregnancy, management, evidence-based care, evidence summary

CLC Number: 

  • R473.6
[1] Blume C, Pischke S, von Versen-Höynck F, et al. Pregnancies in liver and kidney transplant recipients: a review of the current literature and recommendation[J]. Best Pract Res Clin Obstet Gynaecol, 2014,28(8):1123-1136. DOI:10.1016/j.bpobgyn.2014.07.021.
[2] Gonzalez Suarez ML, Parker AS, Cheungpasitporn W.Pregnancy in kidney transplant recipients[J]. Adv Chronic Kidney Dis, 2020, 27(6):486-498. DOI:10.1053/j.ackd.2020.06.004.
[3] 林韦彤. 肾移植术后育龄女性孕前妊娠风险管理知信行现状及影响因素研究[D].长沙:中南大学,2022.
[4] 刘瑞红,张霞,万晶晶,等.肾移植术后妊娠风险评估研究进展[J].护理学报,2018,25(2):33-36.DOI:10.16460/j.issn1008-9969.2018.02.033.
[5] Mohammadi FA, Borg M, Gulyani A, et al.Pregnancy outcomes and impact of pregnancy on graft function in women after kidney transplantation[J]. Clin Transplant, 2017, 31(10). DOI:10.1111/ctr.13089.
[6] 艾亮,张盛,刘炼,等.肾移植术后妊娠受者全程健康管理单中心经验[J].中华移植杂志(电子版),2021,15(2):105-107.DOI:10.3877/cma.j.issn.1674-3903.2021.02.008.
[7] 徐玉林,张春秀.慢性肾脏病患者妊娠管理相关指南的质量评价及内容分析[J].护理学报,2021,28(11):56-61.DOI:10.16460/j.issn1008-9969.2021.11.056.
[8] 周朝霞,谭其玲,赵上萍,等.肾移植女性受者妊娠管理的研究进展[J].护理学杂志,2022,37(14):19-22.DOI:10.3870/j.issn.1001-4152.2022.14.019.
[9] Foster MJ, Shurtz S.Making the critical appraisal for summaries of evidence (CASE) for evidence-based medicine (EBM):critical appraisal of summaries of evidence[J].J Med Libr Assoc,2013,101(3):192-198. DOI:10.3163/1536-5050.101.3.008.
[10] Brouwers MC, Kho ME, Browman GP, et al. AGREE Ⅱ: advancing guideline development, reporting and evaluation in health care[EB/OL].(2017-12-15)[2023-05-02]. http://www.agreetrust.org.
[11] The Joanna Briggs Institute(JBI). Checklist for systematic reviews[EB/OL]. (2017-07-15)[2024-01-10]. https://jbi.global/critical-appraisal-tools.
[12] 王春青,胡雁.JBI证据预分级及证据推荐级别系统(2014版)[J].护士进修杂志,2015(11):964-967.DOI:10.16821/j.cnki.hsjx.2015.11.002.
[13] Rojas R, Palmer BF. Sexual and reproductive health after kidney transplantation[EB/OL]. (2022-02-02)[2023-05-02].http://update.0000.tsg211.com/contents/sexual-and-reproductive-health-after-kidney-transplantation.
[14] De Jong MFC, Van Hamersvelt HW, Van Empel IWH, et al.Summary of the dutch practice guideline on pregnancy wish and pregnancy in CKD[J]. Kidney Int Rep, 2022, 7(12): 2575-2588. DOI:10.1016/j.ekir.2022.09.029.
[15] Shokeir AA, Hassan S, Shehab T, et al.Egyptian clinical practice guideline for kidney transplantation[J].Arab J Urol, 2021,19(2):105-122.DOI:10.1080/2090598X.2020.1868657.
[16] Wiles K, Chappell L, Clark K,et al.Clinical practice guideline on pregnancy and renal disease[J].BMC Nephrol, 2019, 20(1): 401. DOI:10.1186/s12882-019-1560-2.
[17] National lnstitute for Health and Care Excellence. Intrapartum care for women with existing medical conditions or obstetric complications and their babies[EB/OL].(2019-04-25)[2023-05-02].https://www.nice.org.uk/guidance/ng121.
[18] Baker RJ, Mark PB, Patel RK, et al.Renal association clinical practice guideline in post-operative care in the kidney transplant recipient[J]. BMC Nephrol, 2017, 18(1): 174. DOI:10.1186/s12882-017-0553-2.
[19] Society for Maternal-Fetal M, Irani RA, Coscia LA, et al. Society for maternal-fetal medicine consult series #66: pre-pregnancy evaluation and pregnancy management of patients with solid organ transplants[J].Am J Obstet Gynecol, 2023. DOI:10.1016/j.ajog.2023.04.022.
[20] 广东省药学会.肾移植患者免疫抑制剂长期管理医药专家共识[J].今日药学,2022,32(11):801-816.DOI:10.12048/j.issn.1674-229X.2022.11.001.
[21] Nelson J, Alvey N, Bowman L, et al.Consensus recommendations for use of maintenance immunosuppression in solid organ transplantation: Endorsed by the American College of Clinical Pharmacy, American Society of Transplantation, and the International Society for Heart and Lung Transplantation[J]. Pharmacotherapy, 2022,42(8):599-633. DOI:10.1002/phar.2716.
[22] Ogunwole SM, Chen X, Mitta S, et al.Interconception care for primary care providers: consensus recommendations on preconception and postpartum management of reproductive-age patients with medical comorbidities[J]. Mayo Clin Proc Innov Qual Outcomes, 2021, 5(5):872-890. DOI:10.1016/j.mayocpiqo.2021.08.004.
[23] Cabiddu G, Spotti D, Gernone G, et al.A best-practice position statement on pregnancy after kidney transplantation: focusing on the unsolved questions. The Kidney and Pregnancy Study Group of the Italian Society of Nephrology[J]. J Nephrol, 2018,31(5):665-681.DOI:10.1007/s40620-018-0499-x.
[24] Gong X, Li J, Yan J, et al.Pregnancy outcomes in female patients exposed to cyclosporin-based versus tacrolimus-based immunosuppressive regimens after liver/kidney transplantation: a systematic review and Meta-analysis[J]. J Clin Pharm Ther, 2021,46(3):744-753. DOI:10.1111/jcpt.13340.
[25] Perez-Garcia LF, Dolhain R, Vorstenbosch S, et al.The effect of paternal exposure to immunosuppressive drugs on sexual function, reproductive hormones, fertility, pregnancy and offspring outcomes: a systematic review[J]. Hum Reprod Update, 2020, 26(6): 961-1001.DOI:10.1093/humupd/dmaa022.
[26] van Buren MC, Schellekens A, Groenhof TKJ, et al. Long-term graft survival and graft function following pregnancy in kidney transplant recipients: a systematic review and Meta-analysis[J]. Transplantation, 2020, 104(8): 1675-1685. DOI:10.1097/TP.0000000000003026.
[27] Shah S, Venkatesan RL, Gupta A, et al.Pregnancy outcomes in women with kidney transplant: Meta-analysis and systematic review[J]. BMC Nephrol, 2019, 20(1): 24. DOI:10.1186/s12882-019-1213-5.
[28] 冯晓冰,徐婷婷,宋涂润,等.肾移植受者术后妊娠的回顾性队列研究[J].中华器官移植杂志,2021, 42(5):269-273.DOI:10.3760/cma.j.cn421203-20210405-00120.
[29] Jesudason S, Piccoli GB.Pregnancy outcomes after kidney transplantation: the challenges of success[J]. Kidney Int, 2022, 102(4): 697-699. DOI:10.1016/j.kint.2022.08.007.
[30] Szpotanska-Sikorska M, Mazanowska N, Kociszewska-Najman B, et al.Unintended pregnancies and family planning among women after kidney or liver transplantation[J]. J Matern Fetal Neonatal Med, 2020, 33(8): 1346-1352. DOI:10.1080/14767058.2018.1518420.
[31] Jesudason S, Williamson A, Huuskes B, et al.Parenthood with kidney failure: answering questions patients ask about pregnancy[J]. Kidney Int Rep, 2022,7(7):1477-1492. DOI: 10.1016/j.ekir.2022.04.081.
[32] Schwarz A, Schmitt R, Einecke G, et al.Graft function and pregnancy outcomes after kidney transplantation[J]. BMC Nephrol, 2022, 23(1):27.DOI:10.1186/s12882-022-02665-2.
[33] Lu J, Hewawasam E, Davies CE, et al.Preeclampsia after kidney transplantation: rates and association with graft survival and function[J]. Clin J Am Soc Nephrol, 2023, 18(7):920-929. DOI:10.2215/CJN.0000000000000155.
[34] Longhitano E, Zirino F, Calabrese V, et al.Commonly used immunosuppressive drugs for kidney diseases and pregnancy: focus on open questions[J]. Expert Rev Clin Pharmacol, 2021, 14(11):1321-1323.DOI:10.1080/17512433.2021.1968831.
[35] 王红梅,王谢桐.肾脏病史女性孕前保健[J].中国实用妇科与产科杂志,2018, 34(12):1342-1345. DOI:10.19538/j.fk2018120111.
[36] Agarwal KA, Pavlakis M. Sexuality, Contraception,pregnancy in kidney transplantation[J]. Kidney Med, 2021, 3(5): 837-847. DOI:10.1016/j.xkme.2021.05.009.
[37] 祝彩霞,王马列,杨娟,等.妊娠合并肾移植术后的妊娠结局分析[J].中山大学学报(医学科学版),2021,42(6):900-905.DOI:10.13471/j.cnki.j.sun.yat-sen.univ(med.sci).2021.0611.
[1] ZHOU Hong, WANG Yuan, DING Liwen, ZHAO Yulei, PANG Yan, WU Nana, CHEN Xia, FU Jie, WU Han, FAN Wenzhuo. Application of GutCheckNEC-SBAR in whole process management of medical staff communication in neonatal ward [J]. Journal of Nursing, 2025, 32(6): 17-22.
[2] SUN Chunyan, CAI Minyi, LIU Xiaoyu, XIE Meixiang, QIN Liuye, WANG Li, LI Huiping. Qualitative studies on healthcare providers’ experiences in managing non-suicidal self-injury patients: a Meta-synthesis [J]. Journal of Nursing, 2025, 32(5): 47-52.
[3] LI Jiang-wei, WANG Shu-jun, LI Chang-zai, HU Bao-shan, JIAO Gui-mei, ZHANG Wei-hong. Effects of nursing intervention based on stress and coping theory on psychological stress, negative emotions and self-management in patients with permanent enterostomy after surgery for colorectal cancer [J]. Journal of Nursing, 2025, 32(4): 64-69.
[4] MA Xiao-lan, XU Wei-fang. Application effect of ice water spray based on symptom management theory in thirsty patients undergoing thoracoscopic lobectomy [J]. Journal of Nursing, 2025, 32(4): 70-73.
[5] WU Chao-yu, LIU Shang-kun. Crisis management competence of nurses in post-anesthesia care unit: a qualitative study [J]. Journal of Nursing, 2025, 32(3): 17-21.
[6] LI Ruo-Yu, LIU Xin, LIN Ping, CHEN Dan, LIN Hua. Best evidence summary for medication safety management for discharged patients [J]. Journal of Nursing, 2025, 32(3): 50-55.
[7] YANG Bei, YE Hong-fang, ZHANG Ning, XIANG Lu-wei, LU Shi-yu. Current status of physical activity and its influencing factors in elderly patients with type 2 diabetes [J]. Journal of Nursing, 2025, 32(2): 7-12.
[8] ZHU Tian-shun, ZHU Ke-ke, XUE Hui-yuan, JIAO Cong-cong, WEI Chang-hui, WANG He. Application of message framing theory in health management: a scoping review [J]. Journal of Nursing, 2025, 32(2): 44-49.
[9] YAN Ya-ling, LE Mei-ni, YAO Tao-qin, WANG Xue-lian, JIANG Jian-ling, XIN Yi. Construction of perioperative frailty management program for elderly patients with gastrointestinal tumors [J]. Journal of Nursing, 2025, 32(2): 74-78.
[10] BI Ya-xin, DUAN Ye, HE Li-jun, XU Miao, GONG Rong-hua. Best evidence summary for prevention and management of osteoporosis after metabolic, bariatric surgery [J]. Journal of Nursing, 2025, 32(1): 44-49.
[11] WEN Min, CHEN Bing, ZHOU Yong-ling, LIU Juan, ZHU Xiao-dan. Construction of joint intervention program of cognitive remediation based on mobile health APP for schizophrenia patients [J]. Journal of Nursing, 2024, 31(9): 1-4.
[12] YE Xiang, LI Kai, HUANG Min, ZHANG Qian, LI Ji-min, LIU Rong-zhen, MENG Min, ZHU Shao-yu, XIE Cui-hua. Mobile APP plus family management of blood glucose for adult patients with type 2 diabetes [J]. Journal of Nursing, 2024, 31(9): 60-65.
[13] ZHENG Tao-hua, GAO Xiang, KANG Mei, WEI Hai-xia, LIU Xiao, ZHANG Li. Application of 4R Crisis Management Theory in risk management of hypoglycemia during peri-colonoscopy period [J]. Journal of Nursing, 2024, 31(7): 22-26.
[14] NI Le-feng, LIU Lin, SHEN Chun-hua, QIAO Yao, ZHOU Liang, ZHU Qiang, GONG Wei-juan. Quality evaluation and content analysis of guidelines for time limit management in transfusion nursing [J]. Journal of Nursing, 2024, 31(7): 51-56.
[15] LI Ai-qun, LI Li-hua, WANG Fang, JIANG Yuan-yuan, CAI Yi-min. Mediating effects of chronic disease resource utilization between self-transcendence and self-management behaviors in coronary artery disease patients after PCI [J]. Journal of Nursing, 2024, 31(6): 13-17.
Viewed
Full text


Abstract

Cited
  Shared   
No Suggested Reading articles found!