Segurança da Gestação Após Transplante de Órgãos Sólidos: Uma Revisão de Escopo
Palavras-chave:
Transplante de Órgãos, Revisão de Escopo, Saúde Materno-Infantil, ImunossupressoresResumo
Objetivo: Realizar uma revisão de escopo para identificar o acompanhamento clínico da gestação em mulheres submetidas a transplantes de fígado, rim, coração e pulmão, com o objetivo de verificar a segurança da gestação nesse contexto. Metodologia: Trata-se de uma revisão de escopo realizada a partir de pesquisa nas bases de dados Medical Literature Analysis and Retrieval System Online (MEDLINE/PubMed), Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS) e Scientific Electronic Library Online (SciELO), contemplando os estudos de 2014 a 2024. Resultados: Foram incluídos 45 estudos, selecionados a partir de 1.206 registros, com predominância de publicações sobre transplante renal (77,7%). Observou-se que a idade materna no momento da concepção variou entre 18 e 45 anos. Os desfechos neonatais foram avaliados em 71% dos estudos, que relataram ampla variação na idade gestacional ao nascimento, com registros desde 24 semanas até idades gestacionais superiores a 37 semanas. Também foram reportados pesos ao nascer variando de 554 g a 4.256 g, taxas de aborto entre 3% e 41% e ocorrência de malformações congênitas entre 3% e 21%. Em relação aos desfechos maternos, abordados por 84%, os dados apontam para uma prevalência de alterações da pressão arterial, pré-eclâmpsia e diabetes gestacional. Os imunossupressores foram abordados em 68% dos estudos, com ampla utilização de tacrolimo, enquanto o micofenolato foi sistematicamente contraindicado devido ao seu reconhecido potencial teratogênico. Conclusão: Os resultados demonstraram que a gestação após a realização de um transplante é viável e segura. De acordo com os estudos incluídos, os principais fatores determinantes para a segurança materno-fetal incluem intervalo mínimo entre o transplante e a concepção de 12 meses, planejamento familiar, função estável do enxerto e ausência de uso de micofenolato. A revisão contribui para orientar condutas clínicas baseadas em evidências no contexto da gestação pós-transplante.
Downloads
Referências
1. Global Observatory on Donation and Transplantation. Global Report 2023. Madrid; 2023. [access on 2025 Sep 28]. Available at: https://www.transplant-observatory.org/2023-global-report-%E2%80%8E/.
2. Fuchs KM, Coustan DR. Immunosuppressant therapy in pregnant organ transplant recipients. Semin Perinatol. 2007 Dec; 31(6): 363-371. https://doi.org/10.1053/j.semperi.2007.09.006.
3. Radaelli E, et al. Gestação após transplante renal: 40 anos de experiência em centro único. Braz J Nephrol. 2024; 46(2): e20230061. https://doi.org/10.1590/2175-8239-JBN-2023-0061pt.
4. Ministério da Saúde. Relatório de consulta pública: protocolo clínico e diretrizes terapêuticas – imunossupressão no transplante renal. Brasília: Conitec; 2020. [access on 2025 Oct 2]. Available at: https://www.gov.br/conitec/pt-br/midias/consultas/relatorios/2020/relatorio_pcdt_imunossupressao_em_transplante_renal_cp_28_2020.pdf.
5. Wise A, et al. Pregnancy after kidney and liver transplantation. S Afr Med J. 2024 Apr; 114 (3b): e1240. https://doi.org/10.7196/SAMJ.2024.v114i3b.1240.
6. Murray JE, Reid DE, Harrison JH, Merrill JP. Successful pregnancies after human renal transplantation. N Engl J Med. 1963 Aug; 269(7): 341-343. https://doi.org/10.1056/NEJM196308152690704.
7. Surita FG, Guida JPS, Juliato CR, Boin IF. Gestação e planejamento reprodutivo em mulheres transplantadas. Braz J Transplant. 2023; 26(1): e3623. https://doi.org/10.53855/bjt.v26i1.542_PORT.
8. Yo JH, et al. Adverse pregnancy outcomes in solid organ transplant recipients: a systematic review and meta-analysis. JAMA Netw Open. 2024 Aug; 7(8): e2430913. https://doi.org/10.1001/jamanetworkopen.2024.30913
9. Tricco AC, et al. A scoping review on the conduct and reporting of scoping reviews. BMC Med Res Methodol. 2016 Feb; 16 (15). https://doi.org/10.1186/s12874-016-0116-4.
10. Tricco AC, et al. PRISMA extension for scoping reviews (PRISMA-ScR): checklist and explanation. Ann Intern Med. 2018 Sep; 169 (7): 467-473. https://doi.org/10.7326/M18-0850.
11. Kubo S, Uemoto S, Furukawa H, Umeshita K, Tachibana D; Japanese Liver Transplantation Society. Pregnancy outcomes after living donor liver transplantation: results from a Japanese survey. Liver Transpl. 2014 May; 20 (5): 576-583. https://doi.org/10.1002/lt.23837.
12. Mohamed-Ahmed O, et al. Pregnancy outcomes in liver and cardiothoracic transplant recipients: a UK national cohort study. PLoS One. 2014 Feb; 9(2): e89151. https://doi.org/10.1371/journal.pone.0089151.
13. Rafie S, Lai S, Garcia JE, Mody SK. Contraceptive use in female recipients of a solid-organ transplant. Prog Transplant. 2014 Dec; 24(4): 344-348. https://doi.org/10.7182/pit2014426.
14. Rupley DM, Janda AM, Kapeles SR, Wilson TM, Berman D, Mathur AK. Preconception counseling, fertility, and pregnancy complications after abdominal organ transplantation: a survey and cohort study of 532 recipients. Clin Transplant. 2014 Jun; 28(9): 937-945. https://doi.org/10.1111/ctr.12393.
15. Songin T, et al. Pregnancy after kidney and liver transplantation: its outcome and effect on the graft, mother, and neonate. Ann Transplant. 2014 Dec; 19: 660-666. https://doi.org/10.12659/AOT.892232.
16. Westbrook RH, et al. Outcomes of pregnancy following liver transplantation: the King’s College Hospital experience. Liver Transpl. 2015 Sep; 21 (9): 1153-1159. https://doi.org/10.1002/lt.24182.
17. Candido C, et al. Gestação após o transplante renal: alto índice de complicações maternas. J Bras Nefrol. 2016 Dec; 38 (4):421-426. https://doi.org/10.5935/0101-2800.20160067.
18. Li Y-P, Shih J-C, Lin S-Y, Lee C-N. Pregnancy outcomes after kidney transplantation: a single-center experience in Taiwan. Taiwanese J Obstet Gynecol. 2016 Jun; 55(3): 314-318. https://doi.org/10.1016/j.tjog.2016.04.004
19. Majak GB, et al. Pregnancy outcomes following maternal kidney transplantation: a national cohort study. Acta Obstet Gynecol Scand. 2016 Jun; 95(10): 1153-1161. https://doi.org/10.1111/aogs.12937.
20. Mishra VV, Nanda SS, Mistry K, Choudhary S, Aggarwal R, Vyas BM. An overview on fertility outcome in renal transplant recipients. J Obstet Gynaecol India. 2016 Jun; 66 (Suppl 1): 330-334. https://doi.org/10.1007/s13224-016-0919-6.
21. Rose C, Gill J, Zalunardo N, Johnston O, Mehrotra A, Gill JS. Timing of pregnancy after kidney transplantation and risk of allograft failure. Am J Transplant. 2016 Aug; 16 (8): 2360-2367. https://doi.org/10.1111/ajt.13773.
22. Stoumpos S, et al. Obstetric and long-term kidney outcomes in renal transplant recipients: a 40 year single-centre study. Clin Transplant. 2016 Mar; 30 (6): 673-681. https://doi.org/10.1111/ctr.12732.
23. Amine BHH, Haythem S, Kais H, Radhouane R. Pregnancy after renal transplantation: a retrospective study at the military hospital of Tunis from 1992 to 2011. Pan Afr Med J. 2017; 28 (137). https://doi.org/10.11604/pamj.2017.28.137.6287.
24. King KW, Baca MJ, Armenti VT, Kaplan B. Pregnancy outcomes related to mycophenolate exposure in female kidney transplant recipients. Am J Transplant. 2017 Jan; 17 (1): 151-160. https://doi.org/10.1111/ajt.13928.
25. Majak GB, et al. Preeclampsia in kidney transplanted women: outcomes and a simple prognostic risk score system. PLoS One. 2017 Mar; 12 (3): e0173420. https://doi.org/10.1371/journal.pone.0173420.
26. Mattila M, Kemppainen H, Isoniemi H, Polo-Kantola P. Pregnancy outcomes after liver transplantation in Finland. Acta Obstet Gynecol Scand. 2017 Jun; 96 (9): 1106-1111. https://doi.org/10.1111/aogs.13175.
27. Midtvedt K, Bergan S, Reisæter AV, Vikse BE, Åsberg A. Exposure to mycophenolate and fatherhood. Transplantation. 2017 Jul; 101 (7): e214-e217. https://doi.org/10.1097/TP.0000000000001747.
28. Piccoli GB, et al. Outcomes of pregnancies after kidney transplantation: lessons learned from CKD. A comparison of transplanted, nontransplanted chronic kidney disease patients and low-risk pregnancies a multicenter Nationwide analysis. Transplantation. 2017 Oct; 101 (10): 2536-2544. https://doi.org/10.1097/TP.0000000000001645.
29. Bry C, et al. Pregnancy after lung and heart–lung transplantation: a French multicentre retrospective study of 39 pregnancies. ERJ Open Res. 2019; 5 (4): 00254-2018. https://doi.org/10.1183/23120541.00254-2018.
30. Yoshikawa Y, Uchida J, Akazawa C, Suganuma N. Associations between physical and psychosocial factors and health-related quality of life in women who gave birth after a kidney transplant. Int J Womens Health. 2018 Jun; (10): 299-307. https://doi.org/10.2147/IJWH.S152750.
31. Al-Otaibi T, et al. Pregnancy after renal transplant: single center experience from the Middle East in patients using different calcineurin inhibitors. Exp Clin Transplant. 2019 Jan; 17 (Suppl 1): 99-104. https://doi.org/10.6002/ect.MESOT2018.O42.
32. Bachmann F, et al. Pregnancy following kidney transplantation: impact on mother and graft function and focus on childrens’longitudinal development. BMC Pregnancy Childbirth. 2019 Oct; 19 (376). https://doi.org/10.1186/s12884-019-2496-z.
33. Mariano S, et al. Pregnancy among women with kidney transplantation: a 20-year single-center registry. Rev Bras Ginecol Obstet. 2019 Aug; 41(7): 419-424. https://doi.org/10.1055/s-0039-1688834
34. Yun BH, Joo DJ, Seo SK, Cho SH, Choi YS, Lee BS. Effect of deflazacort on pregnancy outcome in kidney transplant patients: should we change the immunosuppressant before conception? BMC Nephrol. 2019 May; 20 (161). https://doi.org/10.1186/s12882-019-1346-6.
35. Borek-Dziecioł B, et al. Selected biochemical parameters in children of mothers after kidney transplantation. Transplant Proc. 2020 Oct; 52 (8): 2294-2298. https://doi.org/10.1016/j.transproceed.2020.02.100.
36. Naya I, et al. Pregnancy outcomes following pediatric liver transplantation: a single-center experience in Japan. Ann Transplant. 2020 Jun; 25: e921193. https://doi.org/10.12659/AOT.921193.
37. Romeo JLR, et al. Influence of pregnancy on long-term durability of allografts in right ventricular outflow tract. J Thorac Cardiovasc Surg. 2020 Apr; 159 (4): 1508-1516. https://doi.org/10.1016/j.jtcvs.2019.08.083.
38. Sivaprasadan S, Mathew JS, Surendran S, Padma UD. Pregnancy after liver transplantation: outcomes from a single-center experience. J Clin Exp Hepatol. 2020 Jul-Aug; 10 (4): 329-333. https://doi.org/10.1016/j.jceh.2019.10.002.
39. Koenjer LM, et al. Comparison of pregnancy outcomes in Dutch kidney recipients with and without calcineurin inhibitor exposure: a retrospective study. Transpl Int. 2021 Nov; 34 (12): 2669-2679. https://doi.org/10.1111/tri.14156.
40. Marzec I, et al. Pregnancy after liver transplant: maternal and perinatal outcomes. BMC Pregnancy Childbirth. 2021 Sep; 21 (627). https://doi.org/10.1186/s12884-021-04104-w.
41. van Buren MC, Beck DK, Lely AT, van de Wetering J, Massey EK. EXPloring attitudes and factors influencing reproductive choices in kidney transplant patients (The EXPECT-study). Clin Transplant. 2021 Aug; 35 (12): e14473. https://doi.org/10.1111/ctr.14473.
42. Yin O, et al. Mode of obstetric delivery in kidney and liver transplant recipients and associated maternal, neonatal, and graft morbidity during 5 decades of clinical practice. JAMA Netw Open. 2021 Oct; 4(10): e2127378. https://doi.org/10.1001/jamanetworkopen.2021.27378.
43. Bedin A, et al. Pregnancies and gynecological follow-up after solid organ transplantation: experience of a decade. J Clin Med. 2022 Aug; 11 (16): 4792. https://doi.org/10.3390/jcm11164792.
44. Gosselink ME, et al. A nationwide Dutch cohort study shows relatively good pregnancy outcomes after kidney transplantation and finds risk factors for adverse outcomes. Kidney Int. 2022 Oct; 102 (4): 866-875. https://doi.org/10.1016/j.kint.2022.06.006.
45. Hewawasam E, et al. Determinants of perinatal outcomes in dialyzed and transplanted women in Australia. Kidney Int Rep. 2022 Jun; 7 (6): 1318-1331. https://doi.org/10.1016/j.ekir.2022.03.015.
46. Schwarz A, et al. Graft function and pregnancy outcomes after kidney transplantation. BMC Nephrol. 2022 Jan; 23 (27). https://doi.org/10.1186/s12882-022-02665-2.
47. van Buren M, et al. Effect of pregnancy on eGFR after kidney transplantation: a national cohort study. Transplantation. 2022 Jun; 106 (6): 1262-1270. https://doi.org/10.1097/TP.0000000000003932.
48. Chung K, et al. Emergent prelabor cesarean delivery in solid organ transplant recipients: associated risk factors and outcomes. Am J Obstet Gynecol MFM. 2023 Feb; 5 (2): 100799. https://doi.org/10.1016/j.ajogmf.2022.100799.
49. Craig AM, et al. Maternal and pregnancy outcomes following heart transplantation in the United States. JACC Heart Fail. 2023 Oct; 11 (12): 1666-1674. https://doi.org/10.1016/j.jchf.2023.08.018.
50. Oki R, et al. Pregnancy complications and impact on kidney allograft after kidney transplantation in IgA nephropathy. Transpl Int. 2023 May; 36: 11220. https://doi.org/10.3389/ti.2023.11220.
51. Stavart L, et al. Pregnancy after kidney transplantation: an observational study on maternal, graft and offspring outcomes in view of current literature. Front Nephrol. 2023 Jul; 3: 1216762. https://doi.org/10.3389/fneph.2023.1216762.
52. Schagen MR, et al. Modelling changes in the pharmacokinetics of tacrolimus during pregnancy after kidney transplantation: a retrospective cohort study. Br J Clin Pharmacol. 2024; 90 (1): 176-188. https://doi.org/10.1111/bcp.15886.
53. Szpotanska-Sikorska M, et al. Family planning and assessment of the frequency of exposure to drugs contraindicated in pregnancies after kidney or liver transplantation: a retrospective cross-sectional study. Transplant Proc. 2024 May; 56 (4): 912-915. https://doi.org/10.1016/j.transproceed.2024.03.011.
54. Yin O, Coscia L, Constantinescu S, Moritz MJ, Afshar Y, Irani RA. Pregnancy after deceased donor vs living donor kidney transplant: associated obstetric and graft outcomes. Am J Obstet Gynecol. 2024 Feb; 230 (2): 256.e1-256. https://doi.org/10.1016/j.ajog.2023.08.009.
55. Associação Brasileira de Transplante de Órgãos, Registro Brasileiro de Transplantes. Dimensionamento dos transplantes no Brasil e em cada estado (2016-2023). São Paulo: ABTO, RBT; 2023. 88 p. [access on 2025 Nov 16]. Available at: https://site.abto.org.br/wp-content/uploads/2024/03/RBT_2023-Populacao_Site.pdf.
56. Constantinescu S, Pai A, Coscia LA, Davison JM, Moritz MJ, Armenti VT. Breastfeeding after solid organ transplantation. Best Pract Res Clin Obstet Gynaecol. 2014 Nov; 28(8): 1163-1173. https://doi.org/10.1016/j.bpobgyn.2014.09.001.
57. Society for Maternal-Fetal Medicine Publications Committee. Prepregnancy evaluation and pregnancy management of patients with solid organ transplants (SMFMC #66). 2023 Aug; B10-B32. https://doi.org/10.1016/j.ajog.2023.04.022
58. Rytz CL, et al. Menstrual abnormalities and reproductive lifespan in females with CKD: a systematic review and metaanalysis. Clin J Am Soc Nephrol. 2022 Dec;17 (12): 1742-1753. https://doi.org/10.2215/CJN.07100622.
59. Palmer BF. Sexual dysfunction in men and women with chronic kidney disease and end-stage kidney disease. Adv Ren Replace Ther. 2003 Jan; 10(1): 48-60. https://doi.org/10.1053/jarr.2003.50003.
60. Parolin MB, Coelho JCU, Balbi E, Wiederkehr JC, Anghinoni M, Nassif AE. Normalização dos ciclos menstruais e gravidez após transplante de fígado. Arq Gastroenterol. 2000 Jan; 37 (1): 3-6. https://doi.org/10.1590/S0004-28032000000100002.
61. Coffin CS, Shaheen AA, Burak KW, Myers RP. Pregnancy outcomes among liver transplant recipients in the United States: a nationwide case-control analysis. Liver Transpl. 2010 Jan; 16 (1): 56-63. https://doi.org/10.1002/lt.21906.
62. Kociszewska-Najman B, et al. Low transfer of tacrolimus and its metabolites into colostrum of graft recipient mothers. Nutrients. 2018 Feb; 10 (3) :267. https://doi.org/10.3390/nu10030267.
63. Zheng S, et al. Tacrolimus placental transfer at delivery and neonatal exposure through breast milk. Br J Clin Pharmacol. 2013 Mar; 76 (6): 988-996. https://doi.org/10.1111/bcp.12122.
64. Agência Nacional de Vigilância Sanitária. Risco de teratogenicidade - Novos aconselhamentos sobre a prevenção de gravidez para mulheres e homens em tratamento com CellCept® (micofenolato de mofetila). São Paulo; 2015. [access on 2025 Nov 16]. Available at: https://www.gov.br/anvisa/pt-br/assuntos/fiscalizacao-e-monitoramento/cartas-aos-profissionais-desaude/2017/cellcept-r-micofenolato-de-mofetila-risco-de-teratogenicidade-e-orientacoes-para-a-prevencao-de-gravidezroche11-de-dezembro-de-2015.
65. Ministério da Saúde. Brasil é o segundo maior transplantador de órgãos do mundo. Brasília; 2022 [access on 2025 Nov 16]. Available at: https://www.gov.br/saude/pt-br/assuntos/noticias/2022/fevereiro/brasil-e-o-segundo-maior-transplantadorde-orgaos-do-mundo.
Downloads
Publicado
Como Citar
Edição
Seção
Licença
Copyright (c) 2026 Luciane Piva Klein, Diego Gnatta
Este trabalho está licenciado sob uma licença Creative Commons Attribution 4.0 International License.
