Hormonal contraception in female transplant recipients

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.
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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.