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目的 探讨女性肾移植受者术后生育对子代、移植肾及自身健康的影响.方法 回顾分析8个器官移植中心自1989年8月至2007年2月的资料,共有22例女性肾移植受者术后妊娠,并各生育子女1名.由专人负责收集、整理受者及其子女的资料,包括受者的年龄、病程、肾移植时间、免疫抑制剂的应用、结婚及孕产时间、妊娠和分娩情况、子女出生情况、喂养方式等,并对其中的18名子女进行了体格检查,记录其身高和体重.结果 22例生育时的年龄为(27.8±2.7)岁,分娩时间为术后(35.1±13.2)个月,孕产期问免疫抑制方案为环孢素A(或他克莫司)、硫唑嘌呤(或霉酚酸酯)和泼尼松联用.其中21例为剖宫产,1例为自然分娩;6名(27.3%)为早产,其余为足月产.22名子女出生时体重为(2944±585)g,均人工喂养,现年龄最大者为18岁,最小者为8个月.3岁、4岁和5岁者的体重分别为(15.2±1.3)kg、(17.0±0.9)kg和(17.8±0.4)kg,身高分别为(99.0±3.6)cm、(106.4±1.3)cm和(109.5±0.7)cm,其他年龄段因样本数太少,未行统计.未发现明显畸形.22例受者在孕产期间并发高血压9例次,肾功能异常和蛋白尿各5例次,肺部感染和心力衰竭各4例次,尿路感染3例次,6例移植肾功能丧失,2例因肺部感染、心力衰竭死亡,1例因慢性排斥反应、移植肾功能丧失、心力衰竭死亡.结论 女性肾移植受者术后若情况允许,可以生育,但有时可对移植肾及自身健康有一定的影响,整个妊娠、生育过程应有产科、移植科以及心内科等医生共同参与指导.

Objective To evaluate the influence of bearing by female recipients after renal transplantation on their offspring, renal grafts and their health. Methods During Aug. 1989 to Feb. 2007, 22 female renal transplant recipients each gave birth to 1 child. The following data were recorded: age of recipients, course of disease, time of transplantation, immunosuppressive agents, time of marriage and pregnancy, the state of parturition, births of offspring, the way of infant feeding, etc. Eighteen offspring received physical examination, and their height and weight were recorded. Results Twenty-two female recipients had childbirth at the age of 27.8±2.7 (35.1±13.2 months after transplantation). Cyclosporine (CsA), azathioprine (or mycophenolate mofetil) and prednisone were used to prevent reject reaction. Twenty-two recipients had cesarean section, and only 1 recipient had natural childbirth. Six children (27.30%) were preterm birth, and all others were term-birth. During the perinatal stage, there were several pregnancy complications, including chronic hypertension (9 cases), renal function dysfunction and proteinuria (cach 5 cases), pulmonary infection and heart failure (each 4 cases), urinary tract infections (3 cases), and graft loss (6 cases). Two of 22 recipients died from pulmonary infection and heart failure, and 1 from chronic rejection, renal failure and heart failure. Conclusion Bearing by female recipients after renal transplantation may not have significant effects on the development of their offspring, but would have negative effects on recipients and renal grafts.