9 years after lung transplantation: I wish to have a child!

Question

Hello, I am 35 years old and had a lung transplantation due to CF in 2003. Now me and my partner we wish to have a child. I do not have any problems since the transplantation and not a single rejection and I am doing very, very well.
My medication is: tacrolimus, MMF, cortisone 5 mg, pantoprazole 40mg and a few vitamins as iron, magnesium and vitamin D. Also with the medication I do not have any problem and I tolerate everything well.
Is it possible? Did this happen before? That a lung transplant recipient gave birth to a baby? And how was the outcome? I wish it soooo much…
Many thanks for a soon answer.

Answer

Dear questioner,
Thank you very much for your question about having children after lung transplantation. I can understand your wish very well and also relive it. However there are several things, that especially in your situation have to be considered.
Of course I am glad, that you do so well 9 years after lung transplantation and that you do not have any severe complications. The fact that you are doing so well is for sure also related to your actual medication and this however represents unfortunately a certain risk for the embryo and the fetus. Most of the drugs which are taken after lung transplantation, have not been tested if the embryo/fetus could be harmed. Furthermore it is not known if these drugs could have in general a negative influence on the later development of the child. In order to prevent a rejection of your lung, you have to take so-called immunosuppressive drugs. It is possible, that these drugs would have in general an influence on the development of the immune system of the child. Concerning this matter there is actually no reliable data available yet. It is also possible that those drugs have done harm to your child in the long runs even if it is born healthy. Also concerning this matter, data is lacking. However there is one case reported in the literature concerning a child after a heart/lung transplantation which has been born with a malign tumor.
Apart from the so-called child’s well-being, there is of course also the question of your well-being. The pregnancy also represents an increased risk for you in the short runs and especially also in the long runs. Infections will be treated less “aggressively” due to pregnancy, in order not to harm the child and it is quite imaginable that you will have a marked deterioration of your lung function after birth. It is also possible that your kidney function will deteriorate markedly due to a so-called pregnancy-hypertension (about half of all women transplanted develop such a hypertension) and that you probably will need permanent dialysis. In addition, it is possible that you will develop a diabetes. The hypertension as well as the diabetes will furthermore have a negative influence on the development of your child. Furthermore, half of the children will be born prematurely, with a consequently negative influence on the later development of the child. There is also the possibility of a so-called CMV-infection with subsequently negative consequences.
In general it can be said, that pregnancies after lung transplantation are regarded as high-risk pregnancies according to the actual literature and also expert opinions of large lung transplantation centers. There is clear consensus that the planning of a pregnancy should only be performed after feedback and in collaboration with an experienced transplantation team.
You should in the end be aware that your lung function can deteriorate after pregnancy and that you will not be able to take fully care of your child due to the necessary, more intensive medical care and therapy. Furthermore it is quite possible that your child will have not only short-term but also long-term damages. This leads in the end also to ethical considerations, which you should discuss absolutely with an experienced transplantation team.
Yours sincerely,
Dr. Markus Hofer

30.07.2012

30.7.12
In general there is data on over 14000 pregnancies after kidney transplantation, however there is only very few data on pregnancies after lung transplantation (about 40 reports since 1989) and even fewer data on pregnancies after lung transplantation in female CF patients. This makes the “quantification” of risks difficult. Even if a pregnancy after lung transplantation represents without doubt a high-risk pregnancy, there is in the end no uniform opinion of experts in weighing the risks of a pregnancy against the wish of the women to have a child. Therefore, the decision for or against a pregnancy remains in the end at the patient and her partner after intensive information and good communication with the transplantation team.
Another expert opinion on the topic can be read under the following link:
ecorn-cf.eu/index.php?id=65&L=0&tx_expertadvice_pi1[showitem]=45&tx_expertadvice_pi1[search]=

D. d'Alquen