Reproductive Health

Discussions about reproductive and sexual health should be included in transition education for the transplant recipient based on the youth’s age, developmental level, and risks. Pediatric transplant providers may feel uncomfortable approaching sexual health due to a limited knowledge base and the sensitivity of the topic, but they can provide general information about reproductive healthcare from the transplant perspective. In-depth discussions should be the responsibility of team members who are experts in this content, have a trusting relationship with teens, and who are comfortable in discussing these issues and answering the AYA’s questions with sensitivity and in confidence. The AYA should be referred to Adolescent Medicine within the pediatric center or to a local gynecology provider to complete an adolescent history and physical examination. The “5 P” assessment may be completed by the pediatric team to understand the youth’s general perspective of sexual health and to engage them in discussion. These five questions address partners, practices, past history of STIs, presentation of STIs, and prevention of pregnancy. 

Helpful links on sexual health assessment:

• Taking a Client-Centered Sexual History
• The Five “P”s
• Explore the 5Ps method for taking a sexual history

• The transplant team should engage the AYA in a general discussion about reproductive health from the transplant perspective. Safe sex practices should be discussed within the context of being immunosuppressed.  Other topics include an overview of contraceptive options, teratogenic medications, and pregnancy outcomes. These patient handouts provide a comprehensive overview for the YA on these topics:   

  • AST WHCOP Contraception Patient Education Handout.pdf 

  • WHCOP-Pregnancy-After-Transplant-Patient-Brochure.pdf 
     

• Female transplant recipients should establish care with a gynecologist prior to transfer to adult care for at least an introductory appointment to discuss reproductive and sexual health topics. 

• Women are advised that pregnancy is usually safe for most transplant recipients, although there are risks based on their health and comorbidities, medications, and the indication for transplant.  When considering family planning, the YA should contact their transplant team, primary care physician, and gynecologist to discuss individual risk factors and guidance.  

• General recommendations for pregnancy after transplant include stable graft function, no recent episodes of rejection within 6-12 months, off all teratogenic medications, normotensive or well-controlled blood pressure with medications, and normal glucose levels or well-controlled diabetes.   

• The Transplant Pregnancy Registry is an excellent resource for information about pregnancy after transplant, current recommendations, and networking and support with peers.    https://www.transplantpregnancyregistry.org 
   

References: 

Ardura MI, et al.. Promoting safe sexual practices and sexual health maintenance in pediatric and young adult solid organ transplant recipients. Pediatr Transplant. 2021 Feb;25(1):e13949. doi: 10.1111/petr.13949. Epub 2021 Jan 25. PMID: 33491268.

Coscia LA et al. Pregnancy after transplant in the older adolescent: Anticipatory guidance for the pediatric provider. Pediatr Transplant. 2024 Jun;28(4):e14752. doi: 10.1111/petr.14752. PMID: 38682682.

Yo JH, Fields N, Li W, et al. Adverse Pregnancy Outcomes in Solid Organ Transplant Recipients: A Systematic Review and Meta-Analysis. JAMA Netw Open. 2024;7(8):e2430913. doi:10.1001/jamanetworkopen.2024.30913

Katz-Greenberg G, et al. American Society of Transplantation Women’s Health Community of Practice Reproductive Health, Contraception and Pregnancy after Transplantation and Living Donation Controversies Conference Participants. Pregnancy After Solid Organ Transplantation: Review of the Evidence and Recommendations. Transplantation. 2025 Sep 1;109(9):1483-1494. doi: 10.1097/TP.0000000000005341. Epub 2025 Mar 13. PMID: 40838865; PMCID: PMC12354071.