Review of the Course and Outcome of 100 Pregnancies in 84 Women Treated With Tacrolimus1

Kainz, Alexander; Harabacz, I.; Cowlrick, Ivor; Gadgil, S.; Hagiwara, Daijiro

doi:10.1097/00007890-200012270-00010

Cited by 254 publications

(140 citation statements)

References 11 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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“…Experience with tacrolimus in pregnancy is limited. Among 100 pregnancies in 84 women treated with tacrolimus, of whom 27 percent were renal transplant recipients, 68 progressed to a live birth, with 60 percent of deliveries being premature (Kaniz and 2000). It has been associated with neonatal hyperkalemia.…”

Section: Tacrolimusmentioning

confidence: 99%

Sexual and Reproductive Function in Chronic Kidney Disease and Effect of Kidney Transplantation

Lessan‐Pezeshki¹,

Ghazizadeh²

2011

After the Kidney Transplant - The Patients and Their Allograft

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“…The risk of preterm delivery is higher in women with transplants (1) and the benefits of breast milk are diverse and substantial, particularly for preterm infants. Large registry series have not identified any increase in birth defects or neonatal complications in the offspring of mothers taking tacrolimus during pregnancy despite evidence of placental transfer (2).…”

Section: Introductionmentioning

confidence: 98%

Breastfeeding and Tacrolimus

Bramham

Chusney

Lee

et al. 2013

Clinical Journal of the American Society of Nephrology

126

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SummaryBackground and objectives Women have traditionally been advised not to breastfeed while taking tacrolimus, based on theoretical risks of neonatal immunosuppression and assumed secretion into breast milk, rather than clinical data suggesting neonatal absorption. The aim of this study was to assess tacrolimus levels in breast milk and neonatal exposure during breastfeeding.Design, setting, participants, & measurements An observational cohort study was performed in two tertiary referral high-risk obstetric medicine clinics. Fourteen women taking tacrolimus during pregnancy and lactation, and their 15 infants, 11 of whom were exclusively breast-fed, were assessed. Tacrolimus levels were analyzed by liquid chromatography-tandem mass spectrometry. Samples from mothers and cord blood were collected at delivery and from mothers, infants, and breast milk postnatally where possible.Results All infants with serial sampling had a decline in tacrolimus level, which was approximately 15% per day (ratio of geometric mean concentrations 0.85; 95% confidence interval, 0.82-0.88; P,0.001). Breast-fed infants did not have higher tacrolimus levels compared with bottle-fed infants (median 1. Conclusions Ingestion of tacrolimus by infants via breast milk is negligible. Breastfeeding does not appear to slow the decline of infant tacrolimus levels from higher levels present at birth. Women taking tacrolimus should not be discouraged from breastfeeding if monitoring of infant levels is available.

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Review of the Course and Outcome of 100 Pregnancies in 84 Women Treated With Tacrolimus1

Abstract: Pregnancy in tacrolimus-treated transplant recipients resulted in a favourable outcome. Complications of the mother and neonate were similar to those previously described with other immunosuppressants.

Cited by 254 publications

References 11 publications

ACG Clinical Guideline: Liver Disease and Pregnancy

ACG Clinical Guideline: Liver Disease and Pregnancy

Sexual and Reproductive Function in Chronic Kidney Disease and Effect of Kidney Transplantation

Breastfeeding and Tacrolimus

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