Transplant group drafting guidelines for recipients who want to conceive


The Japan Society for Transplantation is understood to be drafting guidelines on how to treat women who want to conceive and give birth while taking medication after transplant surgery — the first move of its kind worldwide.

The organization plans to release the guidelines as early as October, when it holds a general meeting. An English-language version is also underway.

Patients who receive donated organs must take an immunosuppressive drug to reduce the risk of rejection. Moreover, some also need to take antihypertensive drugs to counter the increased risk of high blood pressure.

Printed guidance accompanying immunosuppressive drugs warns that pregnant women should avoid them because they may deform the fetus. Also, there is a risk that antihypertensive drugs could result in underdeveloped babies.

But new immunosuppressive drugs developed over the years are known to be less risky for unborn children, leading to a rise in the number of pregnant patients.

The society says that more than 500 kidney recipients, 30 liver recipients, and at least two pancreas transplant patients have given birth following surgery.

At present, it is up to the transplant surgeon or an obstetrician to decide whether it is safe for transplant patients to become pregnant while taking immunosuppressive drugs.

Concerned that the decision varies from one doctor to another, the society decided to draft a set of guidelines.

“Doctors are giving the medication at their own discretion despite the fact that the attached document warns patients against getting pregnant or giving birth,” said society executive Kenji Yuzawa. “That’s a problem.”

Meanwhile, the move is likely to give hope to patients who underwent transplants and had given up on having children.

“More women who are still able to get pregnant are having transplants but there is no information on whether they can get pregnant and give birth afterward,” said Takashi Kenmochi, professor of transplant surgery at Fujita Health University. “Many patients and doctors believe it’s not possible.”

Kenmochi, in charge of drafting the guidelines, said he hopes the document will benefit patients while laying out the risks. He said the guidelines will include measures on the use of immunosuppressive drugs for all transplant surgeries, as well as specific issues that accompany each type of organ transplant.

For instance, kidney, liver or pancreas transplant patients are at low risk of rejection, which means it is safe for them to get pregnant and give birth. But pregnancy is not recommended for heart or lung recipients because they are at high risk of rejection.

The guidelines will mention the fact that immunosuppressive drugs do not affect men’s fertility.

The organization will also create a nationwide data system for those patients to gather information on their treatment and medication after it discloses the guidelines. At present, the National Center for Child Health and Development in Tokyo has started the system for its own patients.

“I hope to create a data (bank where doctors could) put in information on the child born and the organ transplanted, which would serve as a basis for future medicine,” Kenmochi said.