Mycophenolate mofetil embryopathy: A newly recognized teratogenic syndrome

Pérez-Aytés, Antonio; Marín-Reina, Purificación; Bosó, Virginia; Lédo, A. da S.; Carey, John C.; Vento, Máximo

doi:10.1016/j.ejmg.2016.09.014

Cited by 78 publications

(60 citation statements)

References 53 publications

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“…Steroids are usually commenced and weaned, and reintroduced in cases complicated by rejection. MMF is stopped before embryo transfer owing to its teratogenic nature, when it is often replaced with azathioprine ( n = 7; 31.8%), or tacrolimus monotherapy is attempted ( n = 15; 68.2%). The last ten cases (22.2%) performed in Dallas did not receive MMF, instead using tacrolimus and azathioprine as initial maintenance therapy.…”

Section: Immunosuppression and Rejectionmentioning

confidence: 99%

Human uterine transplantation: a review of outcomes from the first 45 cases

Jones

Saso

Bracewell‐Milnes

et al. 2019

BJOG

142

195

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Uterine transplantation restores reproductive anatomy in women with absolute uterine factor infertility and allows the opportunity to conceive, experience gestation, and acquire motherhood. The number of cases being performed is increasing exponentially, with detailed outcomes from 45 cases, including nine live births, now available. In light of the data presented herein, including detailed surgical, immunosuppressive and obstetric outcomes, the feasibility of uterine transplantation is now difficult to refute. However, it is associated with significant risk with more than one-quarter of grafts removed because of complications, and one in ten donors suffering complications requiring surgical repair.Tweetable abstract Uterine transplantation is feasible in women with uterine factor infertility, but is associated with significant risk of complication.

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Section: Immunosuppression and Rejectionmentioning

confidence: 99%

Human uterine transplantation: a review of outcomes from the first 45 cases

Jones

Saso

Bracewell‐Milnes

et al. 2019

BJOG

142

195

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“…Both are available as film‐coated tablets, and MPS has an enteric coating . Exposure to these medications increases the risk of neoplasms and reproductive problems, especially in women who are pregnant or of childbearing age, according to some studies . This, and the fact that there are no manufacturer's recommendations for administration through enteral feeding tubes, causes frustration, making it necessary to follow pharmacotherapeutic guides and other resources in the literature…”

Section: Resultsmentioning

confidence: 99%

Immunosuppressives and enteral feeding tubes: An integrative review

et al. 2019

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What is known and objective: Immunosuppression is the main goal in the treatment of autoimmune diseases, chronic inflammatory diseases, and solid organ and tissue transplantation. However, due to a lack of liquid-form medications, it is challenging to achieve adequate immunosuppression when the patient is using enteral feeding tubes. It is necessary to transform solid oral medications into other forms for administration. Besides that, the occupational risk should be considered, and safetyhandling measures should be taken. This review aimed to investigate the available evidence regarding the use of immunosuppressive drugs through enteral feeding tubes, focusing on the administration technique, efficacy and treatment safety. Methods:We performed an integrative review using the databases PubMed, LILACS, SciELO, Cochrane and Google Scholar, including papers published between 1997 and 2017 in Portuguese, English and Spanish. We excluded editorials, theoretical reflections, abstracts presented at events, dissertations, theses, monographs and studies with extemporaneous formulations administered only by the oral route. In addition, we investigated the references of the included papers, as well as pharmaceutical guides, books and package inserts of selected drugs for additional evidence.Information and recommendations found were analysed and classified according to the GRADE system. Results and discussion:Fifty papers were identified, and 14 met the selection criteria. Among the assessed immunosuppressive drugs, we observed that tacrolimus, mycophenolic acid derivatives and azathioprine were the most studied, and they have more guided recommendations regarding their use through enteral feeding tubes.We noted the need for personal protective equipment for the conversion of the solid oral dosage forms, along with special caution during administration, due to occupational hazard. Other important factors identified were the position of the tube and interactions with the enteral nutrition, because they may compromise absorption, bioavailability and serum blood levels of immunosuppressive agents. However, the studies found have methodological limitations and poor quality, and this was taken into consideration during the classification of the evidence. | 409 e SILVA et AL.

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“…The largest registry is the National Transplantation Pregnancy Registry, which carefully tracks outcomes of transplanted mothers and their offspring . There is general consensus that mycophenolate mofetil is teratogenic, particularly in the first trimester and its use is associated with an increased risk of miscarriage as well as birth defects . Calcineurin inhibitors seem to be reasonably well tolerated although it is possible that they contribute to the increased risk of maternal hypertension and pre‐eclampsia.…”

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confidence: 99%

Pregnancy after heart transplant: not for the faint of heart

Baran

2018

Transpl Int

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Solid organ transplantation has evolved significantly in the last 50 years. When heart transplantation began, patient survival was scarcely past a year[1], and the question of pregnancy for female heart transplant patients was not a significant consideration. Now, since the era of cyclosporine and conventional triple drug therapy, is important to anticipate that women of childbearing age may desire to become pregnant. Since the survival post-transplant for heart patients is an average of 10-12 years (with some surviving 20 years), this is not an unreasonable notion. This article is protected by copyright. All rights reserved.

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Mycophenolate mofetil embryopathy: A newly recognized teratogenic syndrome

Cited by 78 publications

References 53 publications

Human uterine transplantation: a review of outcomes from the first 45 cases

Human uterine transplantation: a review of outcomes from the first 45 cases

Immunosuppressives and enteral feeding tubes: An integrative review

Pregnancy after heart transplant: not for the faint of heart

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