Função reprodutiva e gravidez no pós-transplante hepático: revisão integrativa

Abstract

Liver transplantation (TH) is a treatment modality that consists of replacing the liver of the recipient that no longer responds to other treatments, by a healthy liver from a donor, whether living or dead. In addition to treating underlying liver disease, liver transplantation involves several aspects that encompass the broad concept of quality of life, including the recovery of sexual and reproductive activity, often compromised in this population. The aim of the study is to identify maternal and fetal complications associated with post-transplant pregnancy from evidence from published studies on the subject. This is an integrative review in the literature in the field of nursing. In the search strategy, information resources were used, with access to the Virtual Health Library (VHL) portal and search in Latin American and Caribbean Literature in Health Sciences databases (LILACS), Spanish Bibliographical Index of Sciences of Health Health (IBECs), International Literature on Health Sciences (MEDLINE), Bibliographic Records of the Argentine Republic (BINARCIS) and National Information Center of Medical Sciences of Cuba (CUMED). After thorough reading of the articles in full, the articles that did not attend to the guiding question were excluded, being selected 10 articles, which were part of the discussion of this work. Of the 10 resulting studies in the final sample, eight were found in MEDLINE and two in LILACS. The studies were carried out in the following countries: Turkey, Canada, Belgium, Cuba, Finland, Brazil, Italy and Japan, each contributing one study, and USA, with three studies. The surveys were published between 2009 and 2018. English was considered among the main languages, being also found in Portuguese and Spanish. The main maternal complications that affect pregnancy after liver transplantation were: hypertension, preeclampsia, gestational diabetes, premature rupture of the membrane, renal insufficiency. The fetuses were: premature delivery, low birth weight, growth restriction, congenital anomalies. The main immunosuppressive agents used during post-transplantation during gestation were: mycophenolate mofetil, cyclosporine, azathioprine, prednisone, methyl-prednisolone and tacrolimus and their implications. In addition, the main outcomes (time between conception and HT, neonatal death, delivery and breastfeeding) were summarized in each article. All pregnancies in HT recipients are considered to be high risk, so it is essential to involve a multidisciplinary team to follow up the patient in preconception, pregnancy and postpartum, in which the woman can carry out a pregnancy planning and, thus, , to reduce the complications generated during pregnancy, such as abortion and graft loss.