2020
DOI: 10.1097/ftd.0000000000000769
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Usage of Tacrolimus and Mycophenolic Acid During Conception, Pregnancy, and Lactation, and Its Implications for Therapeutic Drug Monitoring: A Systematic Critical Review

Abstract: Background: Conception, pregnancy, and lactation following solid organ transplantation require appropriate management. The most frequently used immunosuppressive drug combination after solid organ transplantation consists of tacrolimus (Tac) plus mycophenolic acid (MPA). Here, the effects of Tac and MPA on fertility, pregnancy, and lactation are systematically reviewed, and their implications for therapeutic drug monitoring (TDM) are discussed. Methods: A systematic literature search was performed (August 19, … Show more

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Cited by 32 publications
(33 citation statements)
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References 169 publications
(256 reference statements)
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“…They found no difference in malformations nor pre-term deliveries in children fathered by MMF/MPA exposed compared to KT recipients not exposed [24]. The outcomes of pregnancies fathered by male transplant recipients appear similar to those of the general population and MPA embryopathies have not been noted in pregnancies fathered by those patients [21,54]. Our results add to the available data in the literature, that pregnancies fathered by patients under MMF/MPA at the time of conception do not seem to have more complications than pregnancies in the general population…”
Section: Infertility Issuesmentioning
confidence: 92%
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“…They found no difference in malformations nor pre-term deliveries in children fathered by MMF/MPA exposed compared to KT recipients not exposed [24]. The outcomes of pregnancies fathered by male transplant recipients appear similar to those of the general population and MPA embryopathies have not been noted in pregnancies fathered by those patients [21,54]. Our results add to the available data in the literature, that pregnancies fathered by patients under MMF/MPA at the time of conception do not seem to have more complications than pregnancies in the general population…”
Section: Infertility Issuesmentioning
confidence: 92%
“…Of the 330 participants who never had a child, 105 (32%, 95% CI [27][28][29][30][31][32][33][34][35][36][37]) declared that they did not want to conceive after transplantation, 6 (2%, 95% CI [0.7-4]) male KT recipients were concerned about the risk of transmission of polycystic kidney disease (PKD), whereas 55 (17%, 95% CI [13][14][15][16][17][18][19][20][21]) suffered from infertility (Table 1). Childless participants seemed to be younger than the ones who had fathered children before KT (Table 2).…”
Section: Participants Without Children After Transplantationmentioning
confidence: 99%
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“…Of the 5 pregnancies within the partnerships of the participants treated by everolimus, there was one therapeutic abortion due to multiple malformations. The proportion of therapeutic abortions and malformations according to the immunosuppressive agents taken by the father were: 6 of 59 (10%, 95% CI [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] As before the pregnancies the male patients were exposed to co-medication, one outcome can be declared in several columns.…”
Section: Participants Without Children After Transplantationmentioning
confidence: 99%
“…MMF/MPA and sirolimus should be discontinued and replaced by another drug at least six weeks prior to conception [5,7,12,[19][20][21].…”
Section: Introductionmentioning
confidence: 99%