Bearing in mind the current advances in transplantation medicine and surgery and the advent of better immunosuppressive therapy resulting in the improvement in graft survival, recipients have a better quality of life and therefore, it is no surprise that there is an increase of pregnancy rates in this group of women. Since the first successful pregnancy in a renal transplant recipient reported by Murray et al. (1), many centers have contributed to a better understanding and the management of this special group of patients. A significant example of such a contribution is the National Transplantation Pregnancy Registry (NTPR) established by Armenti et al. in 1991 at Thomas Jefferson University, Philadelphia, PA. Data from the NTPR have helped to consolidate the reassurances in publications of smaller experiences that successful pregnancies are possible in the transplant population as well as to keep care givers abreast of important issues such as gestational- and organ-specific problems, the role of the new immunosuppressants, and the remote effects of pregnancy on both graft prognosis and offspring. Registration based on voluntary submission of information will always have worries about ascertainment and indeed, NTPR may not capture more than 40% to 50% of all pregnancies in the United States, but this type of well-organized data collection is still worthwhile. Sadly, the U.K. Registry, with an ascertainment of approximately 90%, was discontinued in 2001, as reported in this journal (2). Brazil is one of the most important centers in the field of organ replacement therapy, mainly regarding renal transplantation (3). In 2008, a total of 3809 renal transplantations were performed countrywide, and there are currently 136 active centers for this procedure in Brazil. Women with end-stage renal disease are frequently infertile and because approximately 20% of the transplanted patients in our country are women of child-bearing age, it is possible that every year more than 600 women could have their fertility capacity restored after renal transplantation. In Brazil, we have noticed that the desire to conceive becomes strong among these women and that, as is already known, pregnancy is not safe in these cases. Previous reports have emphasized the high incidence of hypertension, anemia, renal function deterioration, preeclampsia, preterm delivery, preterm rupture of membranes, fetal growth restriction, and stillbirths (4). In addition, there are special concerns about immunosuppressive therapy during pregnancy because all these patients must maintain their medications. In 2001, in Brazil, to determine the characteristics of pregnant women with renal transplant and their follow-up, a multidisciplinary team was established at the Federal University of Sao Paulo (5). After 8 years of experience, we realized the need to share our experiences with other centers in Brazil and that the best way to do this was to set up a National Registry. The idea of having a Registry was always in the back of our minds, but it was the encouragement received from Professor John M. Davison (Newcastle University, United Kingdom), which prompted us to pursue this endeavor, and for this, our partnership with the Brazilian Association of Organ Transplantation was really decisive. So, we hope now that all registered centers in Brazil will be able to access an electronic form to submit data on pregnancy in renal transplant recipients. These data will be analyzed by a multidisciplinary team, and based on the discussions and conclusions, feedback will be given to all centers. Data may also be published in international journals and in regional informative books to further help and guide medical communities and patients. In summary, this is really a pivotal moment for us, and we believe that important data will accrue the analysis of which will improve clinical outcomes for mothers and their babies and achieve overall a better quality of life for our organ transplant recipients. Leandro G. de Oliveira1 Nelson Sass1 Hélio T. Silva, Jr.1 Jose O.M. Pestana1 Antonio F. Moron1 Marilda Mazalli2 Valter D. Garcia3 1Department of Medicine Federal University of Sao Paulo Sao Paulo, Brazil 2Department of Medicine University of Campinas Sao Paulo, Brazil 3Complexo Hospitalar Santa Casa de Porto Alegre Porto Alegre, Brazil
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