Obstetric and Neonatal Outcome of Pregnancies Fathered by Males on Immunosuppression After Solid Organ Transplantation

Morken, Nils‐Halvdan; Díaz-García, César; Reisæter, Anna Varberg; Foss, Aksel; Leivestad, T.; Geiran, Odd; Hervás, David; Brännström, Mats

doi:10.1111/ajt.13159

Cited by 32 publications

(27 citation statements)

References 34 publications

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“…This comparison was, however, recently performed by Morken et al, 19 but from a different time interval and also including data from other organ transplant recipients. In their analysis, they compared data from 4614 pregnancies before and 474 after transplantation to the outcome in the general population and found an increased risk of preeclampsia.…”

Section: Discussionmentioning

confidence: 99%

Exposure to Mycophenolate and Fatherhood

et al. 2017

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BackgroundMycophenolic acid (MPA) is the active immunosuppressive substance in both mycophenolate mofetil and mycophenolate sodium, and it is widely used after organ transplantation. In women, taking MPA is teratogenic and may also influence spermatogenesis. There is a lack of knowledge regarding outcome of pregnancies fathered by men exposed to MPA.MethodsWe compared outcomes in pregnancies fathered by renal transplant men per whether they had been exposed to MPA or not at time of conception. A nationwide population-based retrospective cohort study was performed. Data from the Norwegian Renal Registry with all renal transplanted men alive between January 1, 1995 and December 31, 2015 were included, and relevant outcome data were extracted from the Medical Birth Registry of Norway.ResultsDuring the given time, 230 immunosuppressed renal transplanted men fathered 350 children (155 on MPA/195 not on MPA). There were no significant increased risks of malformation (3.9% vs. 2.6%, P = 0.49) in MPA exposed versus unexposed cohorts of children. The average dose (±SD) of mycophenolate was 1.42 ± 0.3 g/day and the individual median MPA trough concentration in the time period of anticipated conception and pregnancy was 2.8 ± 1.6 mg/L. Birth weight was similar in exposed and unexposed cohorts of children; 3381 ± 681 g vs. 3429 ± 714 g (P = 0.53).ConclusionsPaternal exposure to MPA did not increase the risk of adverse birth outcomes in children fathered by male kidney transplanted patients. These results are reassuring and support the continuation of paternal MPA treatment before, during, and after conception.

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Section: Discussionmentioning

confidence: 99%

Exposure to Mycophenolate and Fatherhood

et al. 2017

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“…This does not exclude the possibility that it might influence fertility. Indeed, it was reported that there is an increased risk of preeclampsia if the father is treated with MMF [21]. …”

Section: Discussionmentioning

confidence: 99%

Impact of Kidney Transplantation on Reproductive Hormone Levels in Males: A Longitudinal Study

Eckersten

Giwercman

Pihlsgård

et al. 2017

Nephron

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Background/Aims: Male patients with end-stage renal disease suffer from sexual disturbances and infertility. Disturbances in the hypothalamic-pituitary-gonadal axis are one of the causes of this. Decreased testosterone synthesis in Leydig cells of the testes and hyperprolactinemia are common. Kidney transplantation, unlike hemodialysis, normalizes these changes. However, how kidney transplantation affects Sertoli cell function is poorly understood. This study is aimed at investigating the changes in fertility-related hormones in men before, during, and after renal transplantation. Methods: This longitudinal and prospective single center study enrolled 12 men undergoing living donor kidney transplantation. Plasma levels of creatinine, cystatin C, and serum levels of follicle stimulating hormone (FSH), luteinizing hormone (LH), estradiol, testosterone, sex hormone-binding globulin, inhibin B, and anti-Müllerian hormone (AMH) were assayed at 10 different time points before, during, and after kidney transplantation. Results: A rapid decrease in creatinine and cystatin C levels indicated successful renal transplantation. High pre-transplantation plasma levels of prolactin (mean 516 ± 306 mIE/L) and LH (9.4 ± 4.7 IU/L) were normalized after 7 days (248 ± 161 mIE/L and 6.1 ± 3.1 IU/L, respectively). Testosterone decreased rapidly during transplantation and increased again one week post-transplantation. Sertoli cell-derived hormone inhibin B decreased after transplantation, and there was a small non-significant trend of increased AMH after 12 months. Conclusion: Sertoli cell function, based on AMH and inhibin B levels, does not improve to the same extent or as fast as Leydig cell function after kidney transplantation, as determined by testosterone and LH levels.

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“…However, toxicity has not been reported after breastfeeding with ciclosporin, prednisolone, azathioprine and tacrolimus [101, 232]. Aspirin is now widely recommended for the prevention of pre-eclampsia in high-risk populations, and whilst there are no specific data to support its use in KTRs, it seems reasonable to follow this approach, adopted from other guidelines [20, 143]. Outcomes of pregnancies fathered by male KTRs are similar to the general population although reporting bias is difficult to account for [51, 220].…”

Section: Kidney Transplant Recipient (Ktr): Infection Complications (mentioning

confidence: 99%

Renal association clinical practice guideline in post-operative care in the kidney transplant recipient

et al. 2017

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These guidelines cover the care of patients from the period following kidney transplantation until the transplant is no longer working or the patient dies. During the early phase prevention of acute rejection and infection are the priority. After around 3–6 months, the priorities change to preservation of transplant function and avoiding the long-term complications of immunosuppressive medication (the medication used to suppress the immune system to prevent rejection). The topics discussed include organization of outpatient follow up, immunosuppressive medication, treatment of acute and chronic rejection, and prevention of complications. The potential complications discussed include heart disease, infection, cancer, bone disease and blood disorders. There is also a section on contraception and reproductive issues.Immediately after the introduction there is a statement of all the recommendations. These recommendations are written in a language that we think should be understandable by many patients, relatives, carers and other interested people. Consequently we have not reworded or restated them in this lay summary. They are graded 1 or 2 depending on the strength of the recommendation by the authors, and AD depending on the quality of the evidence that the recommendation is based on.

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Obstetric and Neonatal Outcome of Pregnancies Fathered by Males on Immunosuppression After Solid Organ Transplantation

Cited by 32 publications

References 34 publications

Exposure to Mycophenolate and Fatherhood

Exposure to Mycophenolate and Fatherhood

Impact of Kidney Transplantation on Reproductive Hormone Levels in Males: A Longitudinal Study

Renal association clinical practice guideline in post-operative care in the kidney transplant recipient

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