Pregnancy post transplant

[Falkenbach]

Not that I'm seriously considering it BUT it has crossed my mind...

I have never wanted children in the past, and therefore never had any. I am almost 34 and had my transplant more than 18 months ago. I've been told you can have pregnancies post transplant, but just how risky is it? More out of curiosity than anything.

[monrein]

I looked into it but ultimately decided that I didn't want to risk stressing and losing my kidney.  At that time, Cyclosporine was brand new, just out of the testing phase and no one knew what risks it presented to the fetus.  They would have switched me to Immuran just in case and since I was doing really well I wasn't willing to rock the boat.  My sister offered to be a surrogate for my in vitro embryo but when I researched the fertility drugs other concerns came up and there was no clear data on drug interaction between the fertlity drugs and the immunnosuppressives.

I worried about three things mainly.  The first was that I would compromise the health of the baby with all the meds I was on, the second was losing the kidney and the third was that I worried about raising a child in a less than ideal situation if I was back on dialysis and dealing with  all that entails.  We also considered adoption but the third concern was still in play so that was out for us.

We eventually, after much soul-searching and research, decided to borrow and care about our friends kids rather than have our own and my neph felt that was the wisest course of action.  His chief concern was the life of the transplant.  Things are different now probably because there certainly have been post-transplant pregnancies, although I'm not aware of the stats on them.  I do know of one woman who lost her transplant due to the stress of her pregnancy but one situation does not mean much really.  I personally tend to err on the side of caution when it comes to anything that could harm a fetus and affect a child in any negative way at all but this is a very individual decision.  You could ask your neph for articles about the statistical outcomes or risks.

[Falkenbach]

Thank you for your thorough answer, monrein. My biggest concern was losing the transplant, I hadn't even gotten as far as considering the possible effects of medication on the foetus! That should have been the first thing I thought of. 

I did consider whether or not I could provide an ideal environment should dialysis occur in the future, however I also considered the (selfish) issue of whether there would be someone to help look after me.

What you are saying is pretty much what I had considered in my mind - that it is better to be safe than sorry. I work in a cardiology clinic and we see a number of young women coming through with serious congenital heart conditions, aboslutely insisting on getting pregnant. Sigh. There's a million ethical questions on the rights and wrongs, I guess, but I often catch myself shaking my head over these girls' decisions.

[G-Ma]

My primary nurse in center in ND, had a kidney transplant when she was 17 from her twin, then finished HS, college and now has 3 sons, 19, 17 and 12, all pregnancies and deliveries normal and she was a mover, very slender, never followed any sort of a diet, just her meds.

[KT0930]

I had my son 16 years after my first transplant. I was on imuran and prednisone at the time. He's now 10 years old and has ADHD (it has never been remotely suggested that my meds caused that), but otherwise is perfectly healthy.

My neph at the time was wonderful. He and my OB kept in constant contact during my pregnancy, and set me up with a high-risk OB team as well. Despite all the precautions, I developed pre-eclampsia, and they induced my labor at 35 weeks due to my BP being 180/110 for three days.

A few days after my son was born, my creatnine started going up. By his third birthday, we were testing donors for my second transplant. After 18 years, it could have just been time for it to fail, but it could have been the stress of the pregnancy, as well.

Knowing then what I do now, I would still choose to have gotten pregnant, but only because of two things: 1) I could NEVER picture my world without him; and 2) the transplant was already 16 years old, way past the "average", so I probably would have only had an extra couple of years with it, even without the pregnancy. If I had been just a few years into it and had the same outcome, I may feel differently.

[okarol]

When Jenna was 15 years old and diagnosed with ESRD the doctors told us she should never have children. That was 8 years ago. In the last couple of years, since her transplant, they have changed their stance, saying "When you decide to have children, let us know, and we will change your immunosuppressant protocol, Cellcept can cause deformities, so we change your meds during the few months prior to conception, through the pregnancy. Afterward you would resume the CellCept." So the restriction and caution against having children after a transplant has changed over the years.

[paddbear0000]

Cycobully, I'm so glad you brought this up! That was one of the first questions I asked at my first evaluation meeting at my transplant center (Ohio State U.). They told me that it is perfectly safe nowadays as long as they change my meds before trying to get pregnant. They said I had to wait at least a year to make sure the meds "cocktail" is perfected and that rejection episodes are (hopefully) done with. It's nice to hear from others about their experience with this.

[Falkenbach]

That is interesting about cellcept. I am on this also, but when they speak of taking you off the drug for conception and pregnancy, and then restarting it, it makes me think "well then, obviously you must need to stay on it to remain at lowest risk for rejection..." and if so, then is this facet itself actually a risk? Hmmm. Something to ponder.

I think I'm too old for it frankly. Not that I'm too old per se, obviously I'm still quite young. Just too old (and fatigued) for the intense job of parenting. All pregnancy risks increase at around the age of 35. So if I WERE to go for pregnancy, then by the time the meds had been sorted and conception actually achieved, I would BE 35.

[MiSSis]

I had decided many years ago while not in a relationship with anyone to have a tubal ligation.  This came after much soul searching and visiting with 4 different doctors on the subject.  First consideration was of course my transplant but secondly was the lupus which caused my kidney failure in the first place.  I was struggling with the fact that I could possibly pass this trait along to any child I might have.  All four of the docs agreed that while I could be a mother, it would be in my best interest to not carry a baby myself.  So I felt I made the decision in a clinical manner from a medical standpoint.  Fast forward five years and I meet the love of my life.  He's four years younger, divorced with no children, as was I.  Even though I'd told him from the start that if he wanted blond-haired, blue-eyed babies that looked like him, he should look elsewhere, he still chose me.  Naturally my emotions and hormones kicked in and I wanted his baby.  I was 37 at the time.  Because of my tubal, we consulted a fertility doctor who basically spent our time with him talking about adoption and his adopted son.  He was opposed to even considering a reversal not only because they're not always successful but he just didn't feel I should become pregnant much as the other doctors had felt years earlier.  He also have us the statistics for the possibility of Downs Syndromes for women my age which were incredibly high.  By the way, we were charged $500.00 for that visit! 

My best friend asked me as I was considering all the possibilities after my marriage to Dan is if I had a burning desire to have a child.  Because, she said, although well worth it, children are a lot of work.  Maybe it was God's plan all along but fortunately I guess, I didn't have that burning desire to have a child and my husband didn't have it either.  Between us we have 13 nieces and nephews and we now have 14 greats (with more to come) so if we need a "kid-fix" there's always one for us to borrow and return.  And I've come to peace with my decision of many years ago.  My only concern is who will take care of me when I'm old and gray.  My only child is feline and he's a boy so he's not going to be much help!

[okarol]

That is interesting about cellcept. I am on this also, but when they speak of taking you off the drug for conception and pregnancy, and then restarting it, it makes me think "well then, obviously you must need to stay on it to remain at lowest risk for rejection..." and if so, then is this facet itself actually a risk? Hmmm. Something to ponder.

They remove the Cellcept and switch you short-term to another immuno - I can't recall which one - but it is safe for the developing fetus.

Kids are a lot of work (AND $$$!) but I am grateful I was given mine, even with the challenges. But it's definitely a big commitment. I had them at 30, 33, 35 and 40 years old.

[Falkenbach]

The more I think of it, the more I come back to the conclusion that my personal decision is "no". But this is still an interesting topic!

[RichardMEL]

Would you consider adoption? How does your partner feel about this issue?

[MIbarra]

I am too wrapped up in this dilemna. Much of the research I have found suggests it is safe (as safe as it can be) for transplant patients to consider pregnancy as long as their creatinine is below 1.4. Above that and the risk that you will lose your graft increases. I spoke with my neph a few months ago and he suggested I see a perinatoligist to discuss the issue. We have pretty much decided against it since due to the transplant my diabetes is out of whack too and I am now on insulin. We are considering adoption at this time.

[Falkenbach]

I had thought vaguely about adoption but ruled that out, too.