K. Bobrowska

Menstrual Function in Female Liver Transplant Recipients of Reproductive Age

BACKGROUND AND AIM End-stage liver failure is associated with severe abnormalities in menstrual and reproductive function. These abnormalities may be reversed by successful orthotopic liver transplantation (OLT). The aim of the study was to investigate menstrual patterns and sex hormone profiles among female liver transplant recipients of reproductive age. METHODS The study group consisted of 24 women of reproductive age with end-stage liver failure who underwent successful OLT. Menstrual patterns and sex hormone profiles were analyzed before as well as 3 and 12 months after OLT. Twenty-seven healthy women of reproductive age served as controls. Biochemical parameters of liver function were assessed before and after OLT. RESULTS Amenorrhea was the most commonly observed abnormality of menstrual cycle in women with end-stage liver failure (71% of patients). The recurrence of regular menstrual cycles was observed in 35% of patients 3 months after OLT. The percentage increased to 70% at 1 year after grafting and was clearly associated with stabilization of liver function. Similar levels of follicle stimulation hormone (FSH), luteinizing hormone (LH), prolactine (PRL), and testosterone (T) as well as lower levels of estradiol (E(2)), dehydroepiandrostendione sulphate (DHEA-S), and progesterone, (P) were observed in patients with liver failure compared with healthy women. We observed normalization of E(2) and DHEA-S levels after OLT. CONCLUSIONS Amenorrhea, the most common menstrual disturbance in women with end-stage liver failure, may be reversed by OLT. One year after OLT menstrual bleedings were noted in 74% of patients of reproductive age. The recurrence of reproductive function indicated the need for effective and safe family planning methods in that group of patients.

Ultrasonography of the brain, abdomen, and heart in neonates born to liver or renal transplant recipient mothers.

BACKGROUND Pregnancies in graft recipients are associated with increased risk of a number of pathologies. The aim of the study was to analyze results of brain and abdominal ultrasonography and echocardiography (ECHO) in neonates born to liver (LTx) or renal recipients (RTx). MATERIAL/METHODS The study group consisted of 82 neonates born to transplanted women (46 neonates of liver recipients and 36 neonates of renal recipients), enrolled in a retrospective study. The control group consisted of 74 neonates from the general population. Sonographic examination of the brain was performed to check for the presence of intra-/periventricular hemorrhage (IVH/PVH) according to Papile, and periventricular leukomalacia (PVL).The results of abdominal ultrasonography and 2-dimensional echocardiography (ECHO) were compared between the groups. The immunosuppressive therapy used during pregnancy was also analyzed. RESULTS No significant differences were observed between the frequency of IVH in LTx and RTx groups and LTx, RTx, and control groups. Abdominal ultrasonography revealed 1 case of suprarenal hemorrhage, 1 case of cystic kidney, and 3 cases of pyelocalyceal system dilatation in the study group. There were no abnormalities in the echocardiography in 97.8% of children born to mothers after LTx and in 94.4% after RTx. There were significant differences in the immunosuppressive therapy between the pregnant women after LTx and RTx. CONCLUSIONS The risk was not increased in intra-/periventricular hemorrhage and congenital abnormalities of the gastrointestinal tract and heart in neonates of mothers after organ transplantation, regardless of the immunotherapy used, and risk was similar to that of the general population.

Multiple Types of High-Risk Human Papilloma Virus in the Lower Genital Tract of a Female Kidney Recipient: A Case Report

We present a case of a female kidney recipient who was infected with 3 types of high-risk human papilloma viruses. An infection in the lower genital tract led to the development of both neoplastic cervical lesions and vulvar cancer.

Endometrial polyps in female allograft recipients with abnormal bleedings

Introduction Endometrial polyps are a common focal endometrial pathology, with abnormal uterine bleeding (AUB) as a predominant symptom. Although the great majority of cases are benign, premalignancy or malignancy may develop within the polyp. The need for chronic immunosuppressive therapy in solid organ transplanted patients is associated with a significantly increased risk of malignant lesions. Aim of the study Aim of the study was to evaluate the risk of endometrial polyps in solid organ transplanted women with abnormal uterine bleeding. Material and methods The retrospective analysis of 125 cases of AUB in allograft recipients and 200 consecutive cases of AUB in patients from the general population was performed. Pathological findings from dilatation and curettage were analyzed and compared between the groups. Results Endometrial polyps were the only pathological findings in 12% and 21.5% of cases from the study and the control groups, respectively. In each of the groups, one case of endometrial cancer coexisted with an endometrial polyp. If cases of endometrial polyps coexisting with endometrial hyperplasia were taken into account, the rate of endometrial polyps was similar to that observed in the general population (20% vs. 21.5%, respectively). Conclusions Chronic immunosuppression, associated with an increased risk of malignancy, does not increase the risk of endometrial polyps among female graft recipients.

P06.03: Severe fetal hemolytic disease due to anti-E alloimmunization—a case report

Objective: To evaluate the positive predictive value of the middle cerebral artery (MCA) Doppler peak systolic velocity (PSV) measurement > 95th centile for the detection of fetal anemia in pregnancies complicated by red cell alloimmunization. Methods: A retrospective analysis of 41 patients over a 3 year period. In 47 cases an intrauterine fetal transfusion was undertaken between 21 and 35 weeks gestation because of suspected fetal anemia. Deviation of MCA PSV and hemoglobin from the mean/median were expressed as either Z-scores (SDs) or multiples of the median (MoM), respectively. The sensitivity of the 95th centile (> 2SD) of MCA PSV for mild (< 0.85 MoM) and moderate/severe (< 0.65 MoM) anemia were calculated. Results: The sensitivity of the 95th centile of MCA PSV for mild and moderate/severe anemia was 97% and 100%, respectively. There were only 3 false positive MCA PSV tests, two of which were related to the presence of a coincidental fetoplacental vascular tumor causing a hyperdynamic circulation. Conclusions: The 95th centile of the MCA PSV appears to have an equal sensitivity with a low false positive rate for the detection of fetal anemia compared to the 66th centile (1.5MoM), which is the currently recommended standard. Use of the 95th centile would reduce the number of invasive tests required in the management of red blood cell isoimmunised pregnancies.