In the last years, the surgical progress led to progressive increase of number and survival time of transplant female recipients. 

Oral and intrauterine device contraceptives are generally,considered contraindicated,  but if pregnancy occurs in the first year after transplantation, the survival graft may be in danger. While, the quality of life of these women, including sexuality and childbearing,  have become important issues.
Hormonal contraception in female kidney recipients
The choice of an optimal contraception free-risk,  is difficult in allograft recipient woman,even when successful renal transplantation restores normal menstrual cycle and fertility,  in previously uremic patients ⁽¹⁾.

In fact, ovulatory cycles are observed in 72% of these patients ⁽²⁾. In fact, post-transplant diabetes, osteonecrosis, cataracts, and nephrotoxicity may be directly related to the various immunosuppressive drugs currently used. The lowest dose compatible with graft acceptance should help reduce the incidence of these nonfatal but significant complications. 

Patients   with   a   lower   glomerular   filtration   rate   are   more susceptible to the development of secondary hypertension and worse graft survival ⁽³⁾. The development of the graft nephroarteriosclerosis, as a consequence of   hypertension   may   accelerate   the   progression   of   the   post-transplant nephropathy ⁽⁴⁾  Adequate counseling on contraception is imperative in order to avoid   unwanted   pregnancies.  In   fact,  if   pregnancy   occur   too   soon   after transplantation, the   survival   graft   is   in   danger. ⁽¹⁾ 

Nevertheless   these contraindication to hormonal contraception,  in women showing stable graft function and without other risk factors, effective hormonal contraception may be considered ⁽⁵⁾. 

A study carried out on twenty six women with mean serum creatinine of 1.3 mg/dl, taking combined oral contraceptives (20-35 mcg EE and 3th generation of progestins) versus contraceptive patch (20mcg EE and 150mcg norelgestromin)  reported   good   cycle   control   and   high   acceptability   Oral contraceptives   were   discontinued   in   two   cases:  in   one   because   of   deep thrombophlebitis and in another case because of deterioration of liver function.

No other side-effects were reported, until the end of study (18 months). Hormonal contraception   did   not   significantly   influence   body   mass   index, blood pressure, serum creatinine, or other biochemical parameters. Although,  in the first year post-transplant blood pressure may be a non-immunological risk factor in long term graft survival ⁽⁶⁾.

Adequate counseling on contraception is imperative in order to avoid unwanted pregnancies and to delay parenthood for at least 1 year.

Premature delivery is the major problem in these patients and can be avoided by maintaining adequate graft function and controlling hypertension and infections ⁽⁷⁾.

—
Rosa Sabatini
General Hospital Policlinico, University of Bari, Italy
—

REFERENCES

1. Rongieres-Bertrand,  C.,  Fernandez,  H.  (1998). Contraceptive use in female transplant recipients. Contracept. Fertil. Sex, 26(2), 845-50. 
2. Pietrzak, B., Wielgos, M., Kaminski, P., Jabiry-Zieniewicz, Z., Bobrowska, K. (2006). Menstrual cycle and sex hormone profile in kidney-transplanted women. Neuro Endocrinol.Lett,27(1-2), 198-202.
3. Fernandez-Fresnedo,  G.,  Palomar,  R.,  Escallada,  R.,  Martin de Francisco, A.L.,  Cotorruelo,  J.G.,  Zubimendi,  J.A.,  Sanz de Castro,  S.,  Ruiz,  J.C., Rodrigo,  E.,  Arias,  M.  (2001).  Hypertension and long-term renal allograft survival:effect of early glomerular filtration rate. Nephrol. Dial. Transplant, 16(1),105-9.
4. Fabrega,  A.J.,  Lopez –Boado,  M., Gonzales,  S.  (1990).  Problems in the long-term renal allograft recipient. Crit. Care Clin, 6(4), 979-1005. 
5. Pietrzak, B., Kaminski, P., Wielgos, M., Bobrowska, K., Durlik, M. (2006). Combined oral contraception in women after renal transplantation. Nuuro Endocrinol.Lett, 27(5), 679-82.
6. Pietrzak,  B.,  Bobrowska,  K.,  Jabiry-Zieniewicz,  Z.,  Kaminski,  P., Wielgos M.,  Pazik,  J.,  Durlik,  M.  (2007). Oral   and   transdermal   hormonal contraception in women after kidney transplantation. Transplant.  Proc, 39(9), 2759-62.
7. Oko,  A.,  Idasiak-Piechocka,  I.,  Czekalski,  S.  (2001).  Post-transplant nephropathy and arterial hypertension. Przegl. Lek, 58(9), 859-63.