Pregnancy after liver transplantation under tacrolimus

Ashokkumar Jain, Raman Venkataramanan, John J. Fung, J. Carlton Gartner, Jackie Lever, Vijayan Balan, Vijay Warty, Thomas E. Starzl

Research output: Contribution to journalArticle

174 Citations (Scopus)

Abstract

Background. The maternal and fetal risk of pregnancy after organ transplantation under tacrolimus has not been reported. This was prospectively studied in 27 pregnancies by 21 female liver recipients who were treated with tacrolimus before and throughout gestation. Method. Twenty- seven babies were born between October 1990 and April 1996. In 15 cases, samples were obtained at or after delivery and stored (-40°C) for comparison of tacrolimus concentration in the maternal blood with different combinations of cord and infant venous blood, breast milk, or a section of the placenta. Results. The 21 mothers had surprisingly few serious complications of pregnancy and no mortality. Two infants with 23 and 24 weeks gestation died shortly after birth. The mean birth weight of the other 25 was 2638±781 g after a gestational period of 36.0±3.3 weeks. Mean birth weight percentile for gestational age was 50.2±26.2 (median 40). On the day of delivery, the mean tacrolimus concentrations (ng/ml) were 4.3 in placenta versus 1.5, 0.7, and 0.5 in maternal, cord, and child plasma, and 0.6 in the first breast milk specimens. The infants had a 36% incidence of transient perinatal hyperkalemia (K+>7.0 meq/L) and a mild reversible renal impairment, which were thought to reflect in part maternal homeostasis. One newborn had unilateral polycystic renal disease (the only anomaly). All 25 babies have had satisfactory postnatal growth and development with a current mean weight percentile of 62±37 (median 80). Conclusions. Pregnancy by postliver transplant mothers under tacrolimus was possible with a surprisingly low incidence of the hypertension, preeclampsia, and other maternal complications historically associated with such gestations. As in previous experience with other immunosuppressive regimens, preterm deliveries were common. However, prenatal growth for gestational age and postnatal infant growth for post- partum age were normal.

Original languageEnglish (US)
Pages (from-to)559-565
Number of pages7
JournalTransplantation
Volume64
Issue number4
DOIs
StatePublished - Aug 27 1997

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Tacrolimus
Liver Transplantation
Mothers
Pregnancy
Human Milk
Birth Weight
Placenta
Gestational Age
Polycystic Kidney Diseases
Hyperkalemia
Pregnancy Complications
Incidence
Organ Transplantation
Immunosuppressive Agents
Growth
Pre-Eclampsia
Growth and Development
Homeostasis
Parturition
Newborn Infant

All Science Journal Classification (ASJC) codes

  • Transplantation

Cite this

Jain, A., Venkataramanan, R., Fung, J. J., Carlton Gartner, J., Lever, J., Balan, V., ... Starzl, T. E. (1997). Pregnancy after liver transplantation under tacrolimus. Transplantation, 64(4), 559-565. https://doi.org/10.1097/00007890-199708270-00002
Jain, Ashokkumar ; Venkataramanan, Raman ; Fung, John J. ; Carlton Gartner, J. ; Lever, Jackie ; Balan, Vijayan ; Warty, Vijay ; Starzl, Thomas E. / Pregnancy after liver transplantation under tacrolimus. In: Transplantation. 1997 ; Vol. 64, No. 4. pp. 559-565.
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abstract = "Background. The maternal and fetal risk of pregnancy after organ transplantation under tacrolimus has not been reported. This was prospectively studied in 27 pregnancies by 21 female liver recipients who were treated with tacrolimus before and throughout gestation. Method. Twenty- seven babies were born between October 1990 and April 1996. In 15 cases, samples were obtained at or after delivery and stored (-40°C) for comparison of tacrolimus concentration in the maternal blood with different combinations of cord and infant venous blood, breast milk, or a section of the placenta. Results. The 21 mothers had surprisingly few serious complications of pregnancy and no mortality. Two infants with 23 and 24 weeks gestation died shortly after birth. The mean birth weight of the other 25 was 2638±781 g after a gestational period of 36.0±3.3 weeks. Mean birth weight percentile for gestational age was 50.2±26.2 (median 40). On the day of delivery, the mean tacrolimus concentrations (ng/ml) were 4.3 in placenta versus 1.5, 0.7, and 0.5 in maternal, cord, and child plasma, and 0.6 in the first breast milk specimens. The infants had a 36{\%} incidence of transient perinatal hyperkalemia (K+>7.0 meq/L) and a mild reversible renal impairment, which were thought to reflect in part maternal homeostasis. One newborn had unilateral polycystic renal disease (the only anomaly). All 25 babies have had satisfactory postnatal growth and development with a current mean weight percentile of 62±37 (median 80). Conclusions. Pregnancy by postliver transplant mothers under tacrolimus was possible with a surprisingly low incidence of the hypertension, preeclampsia, and other maternal complications historically associated with such gestations. As in previous experience with other immunosuppressive regimens, preterm deliveries were common. However, prenatal growth for gestational age and postnatal infant growth for post- partum age were normal.",
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Jain, A, Venkataramanan, R, Fung, JJ, Carlton Gartner, J, Lever, J, Balan, V, Warty, V & Starzl, TE 1997, 'Pregnancy after liver transplantation under tacrolimus', Transplantation, vol. 64, no. 4, pp. 559-565. https://doi.org/10.1097/00007890-199708270-00002

Pregnancy after liver transplantation under tacrolimus. / Jain, Ashokkumar; Venkataramanan, Raman; Fung, John J.; Carlton Gartner, J.; Lever, Jackie; Balan, Vijayan; Warty, Vijay; Starzl, Thomas E.

In: Transplantation, Vol. 64, No. 4, 27.08.1997, p. 559-565.

Research output: Contribution to journalArticle

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T1 - Pregnancy after liver transplantation under tacrolimus

AU - Jain, Ashokkumar

AU - Venkataramanan, Raman

AU - Fung, John J.

AU - Carlton Gartner, J.

AU - Lever, Jackie

AU - Balan, Vijayan

AU - Warty, Vijay

AU - Starzl, Thomas E.

PY - 1997/8/27

Y1 - 1997/8/27

N2 - Background. The maternal and fetal risk of pregnancy after organ transplantation under tacrolimus has not been reported. This was prospectively studied in 27 pregnancies by 21 female liver recipients who were treated with tacrolimus before and throughout gestation. Method. Twenty- seven babies were born between October 1990 and April 1996. In 15 cases, samples were obtained at or after delivery and stored (-40°C) for comparison of tacrolimus concentration in the maternal blood with different combinations of cord and infant venous blood, breast milk, or a section of the placenta. Results. The 21 mothers had surprisingly few serious complications of pregnancy and no mortality. Two infants with 23 and 24 weeks gestation died shortly after birth. The mean birth weight of the other 25 was 2638±781 g after a gestational period of 36.0±3.3 weeks. Mean birth weight percentile for gestational age was 50.2±26.2 (median 40). On the day of delivery, the mean tacrolimus concentrations (ng/ml) were 4.3 in placenta versus 1.5, 0.7, and 0.5 in maternal, cord, and child plasma, and 0.6 in the first breast milk specimens. The infants had a 36% incidence of transient perinatal hyperkalemia (K+>7.0 meq/L) and a mild reversible renal impairment, which were thought to reflect in part maternal homeostasis. One newborn had unilateral polycystic renal disease (the only anomaly). All 25 babies have had satisfactory postnatal growth and development with a current mean weight percentile of 62±37 (median 80). Conclusions. Pregnancy by postliver transplant mothers under tacrolimus was possible with a surprisingly low incidence of the hypertension, preeclampsia, and other maternal complications historically associated with such gestations. As in previous experience with other immunosuppressive regimens, preterm deliveries were common. However, prenatal growth for gestational age and postnatal infant growth for post- partum age were normal.

AB - Background. The maternal and fetal risk of pregnancy after organ transplantation under tacrolimus has not been reported. This was prospectively studied in 27 pregnancies by 21 female liver recipients who were treated with tacrolimus before and throughout gestation. Method. Twenty- seven babies were born between October 1990 and April 1996. In 15 cases, samples were obtained at or after delivery and stored (-40°C) for comparison of tacrolimus concentration in the maternal blood with different combinations of cord and infant venous blood, breast milk, or a section of the placenta. Results. The 21 mothers had surprisingly few serious complications of pregnancy and no mortality. Two infants with 23 and 24 weeks gestation died shortly after birth. The mean birth weight of the other 25 was 2638±781 g after a gestational period of 36.0±3.3 weeks. Mean birth weight percentile for gestational age was 50.2±26.2 (median 40). On the day of delivery, the mean tacrolimus concentrations (ng/ml) were 4.3 in placenta versus 1.5, 0.7, and 0.5 in maternal, cord, and child plasma, and 0.6 in the first breast milk specimens. The infants had a 36% incidence of transient perinatal hyperkalemia (K+>7.0 meq/L) and a mild reversible renal impairment, which were thought to reflect in part maternal homeostasis. One newborn had unilateral polycystic renal disease (the only anomaly). All 25 babies have had satisfactory postnatal growth and development with a current mean weight percentile of 62±37 (median 80). Conclusions. Pregnancy by postliver transplant mothers under tacrolimus was possible with a surprisingly low incidence of the hypertension, preeclampsia, and other maternal complications historically associated with such gestations. As in previous experience with other immunosuppressive regimens, preterm deliveries were common. However, prenatal growth for gestational age and postnatal infant growth for post- partum age were normal.

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Jain A, Venkataramanan R, Fung JJ, Carlton Gartner J, Lever J, Balan V et al. Pregnancy after liver transplantation under tacrolimus. Transplantation. 1997 Aug 27;64(4):559-565. https://doi.org/10.1097/00007890-199708270-00002