Contraception for renal transplant recipients in the Republic of Ireland : a review

Renal transplantation has extended the duration and quality of life for a growing number of women in the Republic of Ireland. Pregnancy has now become a reasonable and viable option for women who were previously too ill to conceive, leading the Royal college of Obstetricians and Gynaecologists to issue opinions on the management of women with renal disease in pregnancy. In the 10-year period, from 2000 to 2009, 1,412 renal transplants were undertaken at Beaumont Hospital, Dublin. Of these, 541 were female patients and 333 of these women were in the reproductive age group (18-49 years) and thus would have potentially required some method of contraception. Improvements in overall health can lead to an early return to fertility and menstruation following renal transplant. It is recommended that the optimal management after renal transplantation is to ensure graft stability and optimal function before pregnancy is considered. It is also advisable to titrate immunosuppressive medication to the lowest maintenance dose possible to minimise potential fetal effects. Thus, a duration of 1 year post-living donor renal transplant and 2 years post-cadaveric donor transplant is usually quoted before embarking on a pregnancy, although this may vary from case to case. Women of reproductive age undergoing renal transplantation have a need for highly effective contraception. This review provides an overview of methods available in the Republic of Ireland and the evidence for their use in renal transplant recipients.