Pregnancy after liver transplantation with tacrolimus immunosuppression: a single center’s experience update at 13 years1

Jain, Ashokkumar; Reyes, Jorgé; Marcos, Amadeo; Mazariegos, George; Eghtesad, Bijan; Fontes, Paulo; Cacciarelli, Thomas V.; Marsh, J. Wallis; Vera, Michael E. de; Rafail, Ann; Starzl, Thomas E.; Fung, John J.

doi:10.1097/01.tp.0000084823.89528.89

Cited by 194 publications

(168 citation statements)

References 16 publications

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“…Overall, with the exception of mycophenolic acid, the risks of cyclosporine, tacrolimus, AZA, sirolimus, everolimus, and corticosteroids appear low compared with the risks of acute cellular rejection or graft loss with their discontinuation or attenuation. Although a higher risk of prematurity and LBW have been reported, the risks of congenital malformation do not appear to be signifi cantly higher than the risk in the general population, without a specifi c pattern of malformation identifi ed (187)(188)(189)(190)(191)(192). Compared with tacrolimus and cyclosporine, there is less data on the use of everolimus and sirolimus during pregnancy aft er liver transplantation, with more of the data available for kidney transplant recipients.…”

Section: Primary Biliary Cirrhosismentioning

confidence: 99%

ACG Clinical Guideline: Liver Disease and Pregnancy

Tran

Ahn

Reau

2016

American Journal of Gastroenterology

242

257

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Consultation for liver disease in pregnant women is a common and oftentimes vexing clinical consultation for the gastroenterologist. The challenge lies in the need to consider the safety of both the expectant mother and the unborn fetus in the clinical management decisions. This practice guideline provides an evidence-based approach to common diagnostic and treatment challenges of liver disease in pregnant women. Am J Gastroenterol 2016; 111:176-194; doi: 10.1038/ajg.2015 Initial evaluation of pregnant patientA pregnant patient presenting with abnormal liver tests should undergo standard workup as with any non-pregnant individual (strong recommendation, very low level of evidence). Imaging in pregnancyUltrasound is safe and the preferred imaging modality used in assessment of abnormal liver tests suggestive of biliary tract disease (strong recommendation, low level of evidence).Magnetic resonance imaging without gadolinium can be used in the second and third trimester (conditional recommendation, low level of evidence).Computed tomography scans carry a risk of teratogenesis and childhood hematologic malignancies but may be used judiciously with minimized radiation protocols (2-5 rads; conditional recommendation, very low level of evidence). Endoscopy in pregnancyEndoscopy is safe in pregnancy but should be deferred until the second trimester if possible (strong recommendation, low level of evidence).Meperidine and propofol can be used for endoscopic sedation (strong recommendation, moderate level of evidence). Management of biliary disease in pregnancyERCP can be performed when indicated for pregnant women presenting with biliary disease that strongly necessitates intervention such as biliary pancreatitis, symptomatic choledocholithiasis, and/or cholangitis. Minimizing fetal exposure to fl uoroscopy is imperative (strong recommendation, low level of evidence).Symptomatic cholecystitis should be managed with early surgical intervention with laparoscopic cholecystectomy (strong recommendation, low level of evidence). Liver masses in pregnancyAsymptomatic hemangioma and focal nodular hyperplasia do not need routine imaging or surveillance during pregnancy (strong recommendation, very low level evidence).Hepatic adenomas should be monitored with ultrasound during pregnancy for growth. Patients with large adenomas (>5 cm) should be referred for resection prior to pregnancy (strong recommendation, low level of evidence). Hepatitis B in pregnancyActive-passive immunoprophylaxis with hepatitis B immunoglobulin and the HBV vaccination series should be administered to all infants born to HBV-infected mothers to prevent perinatal transmission (strong recommendation, low level of evidence).Women chronically infected with HBV and high viral load (>10 6 log copies/ml (200,000 IU/ml) and higher) should be offered antiviral medication with tenofovir or telbivudine in the third trimester to reduce perinatal transmission of HBV (strong recommendation, low level of evidence).C-section should not be performed electively in HBV-pos...

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Section: Primary Biliary Cirrhosismentioning

confidence: 99%

ACG Clinical Guideline: Liver Disease and Pregnancy

Tran

Ahn

Reau

2016

American Journal of Gastroenterology

242

257

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“…Jain and colleagues have found, in their study (19) , tracheoesophageal fistula and heart valve diseases in one newborn; non-functional unilateral kidney cyst and accessory spleen in another.…”

Section: Discussionmentioning

confidence: 94%

pregnancy after liver transplantation

Serin¹,

Grover²,

Kıran³

et al. 2013

J Turk Soc Obstet Gynecol

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“…Tacrolimus is considered to be a safe drug to use during pregnancy, without presenting any increase in malformation rate with its use. There are no digital defects related with this drug [17][18][19]. Another infant had two development defects: lingual thyroid and interatrial septum defect, and the third infant a pyeloureteral junction stenosis.…”

Section: Discussionmentioning

confidence: 99%

Kidney transplantation during a twin pregnancy. Case report and review of the literature

et al. 2012

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Kidney transplant in a pregnant woman is exceptional, with only six cases being reported. Pregnancy was not known at the time of the transplant in five of these cases. We report the case of a 26-year-old woman who was diagnosed as carrying a twin pregnancy 4 months after starting hemodialysis. In order to improve the survival chances for the twins, she underwent an orthotopic renal transplant from a living donor at 20 weeks of gestation. The allograft functioned immediately and 4 weeks passed without incident. At the 26th week of gestation, the patient had a precipitous labor, delivering two male babies with no malformations, weighing 755 and 890 g, who died due to respiratory failure. The allograft worked normally afterwards. Sixteen months later, the patient delivered a normal 37 weeks' gestation baby. The renal graft continued working normally for the next 20 years, after which signs of chronic allograft nephropathy developed. Azathioprine was replaced with mycophenolate mofetil. At the last evaluation, 23 years after transplant, the patient's serum creatinine was 2.9 mg/dl and her estimated glomerular filtration rate (eGFR) was 22 ml/min/1.73 m 2 . This unique case demonstrates that it is possible to perform an orthotopic kidney transplant in a 20-week twin-gestation, with a long graft survival time.

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Pregnancy after liver transplantation with tacrolimus immunosuppression: a single center’s experience update at 13 years1

Cited by 194 publications

References 16 publications

ACG Clinical Guideline: Liver Disease and Pregnancy

ACG Clinical Guideline: Liver Disease and Pregnancy

pregnancy after liver transplantation

Kidney transplantation during a twin pregnancy. Case report and review of the literature

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