Date Published: 
Wednesday, 5 November, 2014

Iron therapy may become standard of care for pregnant transplant recipients, according to a new literature review

Iron therapy may be recommended during pregnancy for patients who have undergone liver or kidney transplant, new research indicates. The authors of the literature review recommend a haemoglobin level of 10–12 g/dL as a therapeutic goal in this patient group, to be achieved using erythropoietin-stimulating agents (ESAs) and iron therapy. They explain that management of anaemia may help to prevent preterm delivery.

The two most common forms of transplant worldwide are liver and kidney. Iron therapy is important in pregnant liver and kidney transplant recipients (LTRs and KTRs), as anaemia has a greater impact on pre-eclampsia and preterm delivery in this group of patients than in non-transplanted pregnant women. A literature search for articles that present single- or multi-centre results or other data on pregnant LTRs or KTRs was conducted.

The search showed that approximately 75% of all pregnancies ended successfully (defined as a live birth) in this patient group, this is comparable to non-transplanted women (67%), although a direct comparison was not possible as part of the review due to differences in study design. The risk of rejections and organ loss after delivery was approximately 10%. There was a higher overall frequency of pregnancy-associated disorders, such as pre-eclampsia and preterm delivery, and hypertension, new-onset diabetes mellitus and newly arising infections were prevalent in pregnant LTRs and KTRs when compared to non-transplanted pregnant women.

The authors suggest that this patient group may have a comparable pregnancy success rate, despite higher pregnancy-associated disorders, due to a ‘control system’. This system is composed of imaging for risk assessment, infection screening, immunosuppressive therapy choice, and wider overall treatment options, including use of iron therapy.

Iron deficiency and anaemia are more prevalent in pregnant LTRs and KTRs than in non-transplanted pregnant women. KTRs have a decreased renal function and thus have limited erythropoiesis ability. LTRs often have lower haemoglobin synthesis due to the antiproliferative effect of immunosuppressive therapy on red blood cells. While this can be attenuated by the use of ESAs, the authors state that the most important prerequisite for haemoglobin synthesis is iron therapy.

The full article is available in the August issue of Best Practice & Research Clinical Obstetrics and Gynaecology. For information on iron deficiency in obstetrics and gynaecology, please click here.