Delivery Method in Patients After Liver or Kidney Transplantation.

Pregnancy following renal or liver transplant is safe for the mother, fetus, and allograft if standard practice guidelines are strictly followed. Cesarean delivery is often required for the safety of the mother and child. The aim of this paper was the evaluation of delivery method in patients after liver (G1) and kidney transplantation (G2) in comparison with the population of healthy pregnant women (G0). MATERIALS: Retrospective analysis included 51 (G1) and 59 (G2) women who delivered between 2000 and 2016. Control group (G0) consisted of 170 nontransplanted patients, who delivered between 2014 and 2016. The results were compared using nonparametric and parametric tests (Fisher exact test, t test). The SAS 9.2 was used for the analysis. RESULTS: The rate of cesarean delivery was high in all pregnancies following kidney (G1 = 80.4%) or liver transplantation (G2 = 67.8%) compared with control group (G0 = 44.1%; P < .05). The most common indication for cesarean delivery in G1 was gestational hypertension/preeclampsia (n = 18; 43.9%), threatening intrauterine asphyxia (n = 12; 29.3%), and failure to progress (n = 2; 4.9%). The most common indications for cesarean delivery in G2 were threatening intrauterine asphyxia (n = 14; 35%), failure to progress (n = 9; 22.5%), and gestational hypertension/preeclampsia (n = 2; 5%). CONCLUSION: Cesarean delivery in patients after kidney or liver transplantation is performed mainly for obstetric reasons. The reported incidence of cesarean delivery in pregnancy following transplant is high, reflecting the high degree of clinical caution exercised in these patients.

In Vitro Fertilization and Pregnancy Outcomes Among Patients After Kidney Transplantation: Case Series and Single-Center Experience.

INTRODUCTION: Kidney transplantation (KTx) is the treatment of choice in patients with end-stage renal failure. Among various medical issues in female graft recipients, the need for maternity can become an overriding one. Gonadal dysfunction usually resolves within 6 months after transplantation; however, the prevalence of infertility is similar to this in the general population. MATERIALS AND METHODS: This case series describes the experience in infertility treatment and following perinatal care among KTx women who underwent successful in vitro fertilization (IVF). We followed three patients who previously received KTx and underwent IVF between 2014 and 2015. The 34-year-old (patient A) and 39-year-old (patient B) women received single KTx, and the 31-year-old (patient C) woman had received three previous transplantations. Patients A and C were diagnosed with primary tubal factor infertility, while patient B suffered from secondary idiopathic infertility. The stimulation protocols had no influence on their general condition nor graft function. Viable singleton pregnancies were confirmed in all cases. All newborns were born preterm, via cesarean section, as a consequence of severe preeclampsia. Patients A and C gave birth at 34th week of gestation (WG) (A: 1810 g and C: 2295 g), while patient B gave birth at 36th WG (2655 g). Other pregnancy complications were intrauterine growth restriction (patient A) and gestational diabetes mellitus (patient B). Although mild graft dysfunction was observed prior to delivery, all clinical measures and hypertension resolved during the puerperium. CONCLUSIONS: In these cases, pregnancy after KTx did not implicate persistent graft dysfunction. Regardless of the method of conception, pregnancy following KTx is associated with an increased incidence of complications, therefore it requires a multidisciplinary approach. IVF itself seems to be a safe procedure in KTx recipients if the pregnancy is advisable.

Evaluation of functionality in patients with traumatic spinal cord injury.

Background. In order to develop a better picture in the earlier stages of rehabilitation of the functional possibilities of patients with plegia and paresis resulting from spinal damage, the authors have developed a simple functionality scale, involving primarily motor and locomotive capacity.
Material and methods. We analyzed the progress in rehabilitation of 31 patients with plegia or paresis subsequent to spinal cord injury, treated in the Rehabilitation Clinic at the Poznan Academy of Medicine. The evaluation was performad 6-12 months after the injury on a 22-point scale developed for patients with spinal cord injury, dealing with basic motor and locomotor capacity. The results obtained were used to calculate the "functionality index", where full functionality, i.e. 44 points, is treated as 1.0.
Results. The results indicated that the best progress in rehabilitation was achieved by young patients with damage on lower levels and with better initial condition.
Conclusions. The application of this simple scale to assess functionality makes it possible to verify objectively the results in relation to the potential indicated by the level of spinal trauma. It also contributes to better patient motivation and active inclusion in the rehabilitation process.

Polymorphism in the gelatinase B gene and the severity of coronary arterial stenosis.

Gelatinase B, as one of the matrix metalloproteinases, may be relevant to atherogenic plaque development and stability. Recently, a C-1562T substitution in the regulatory region of the gelatinase B gene was shown to up-regulate gelatinase B expression, which could be relevant to both the severity and stability of atherosclerotic plaques. We determined the genotype of 788 angiographically documented Caucasian patients with coronary artery disease (583 males and 205 females; age 56.7+/-0.4 years). The proportions of C/C (77.1%), C/T (21.4%) and T/T (1.5%) genotypes were in Hardy-Weinberg equilibrium, and did not differ between males and females (P>0.05). The frequencies of the rare T allele in patients with angiographically documented coronary artery disease (0.123), a past history of myocardial infarction (0.128) or unstable angina (0.128) were not significantly different from those in patients without such events (0.121, 0.118 and 0.128 respectively; P>0.05). In addition, the rare allele frequencies among patients with no (0.128), one (0.124), two (0.108) or three (0.121) significantly diseased vessels (> or =50% luminal obstruction) were not statistically different (P=0.932). However, the male rare T/T homozygotes had lower waist/hip ratios and levels of high-density lipoprotein cholesterol (HDL-C), and higher total cholesterol/HDL-C ratios, than C/C homozygotes (P<0.05). In conclusion, our study in a large series of angiographically defined patients suggests that the C-1562T polymorphism may not be useful as a predictor of the presence and severity of coronary atherosclerosis.