Pregnancy after liver transplantation with tacrolimus immunosuppression

A single center's experience update at 13 years

Ashokkumar Jain, J. Reyes, Amadeo Marcos, G. Mazariegos, Bijan Eghtesad, Paulo A. Fontes, Thomas V. Cacciarelli, J. Wallis Marsh, Michael E. De Vera, Ann Rafail, Thomas E. Starzl, John J. Fung

Research output: Contribution to journalArticle

133 Citations (Scopus)

Abstract

Background. Chronic liver disease often leads to amenorrhea in women of childbearing age. There are several reports of successful pregnancy after liver transplantation (LTx) with cyclosporine A immunosuppression. Tacrolimus has been increasingly used in solid-organ transplantation, and the effect of the drug on pregnancy is still of interest to clinicians. This study updates our single-center experience. Methods. All pregnancies after LTx with tacrolimus immunosuppression were followed prospectively. Patients' clinical courses during pregnancy and labor along with gestational period and birth weight were catalogued. Changes in liver function, renal function, and immunosuppression also were recorded. The birth weight percentile was calculated on the basis of the gestational period using a standard chart. Results. Thirty-seven mothers delivered 49 babies. Three mothers delivered three times, and six mothers delivered two times. Thirty-six mothers (97%) survived the pregnancy, and 36 allografts (97%) survived. The one death and graft loss was in a patient who demonstrated infra-aortic arterial graft, which clotted by the gravid uterus during labor. The patient developed a gangrenous liver and died before she could undergo retransplantation. The mean gestational period was 36.4±3. 2 weeks, excluding two premature deliveries at 23 and 24 weeks gestation. Twenty-two babies (46.9%) were delivered by cesarean section, and the other babies were delivered vaginally. In addition to the two premature babies, one baby, who was born to a mother with Alagille syndrome, died from congenital birth defects. The rest of the newborns survived. The mean birth weight was 2,797±775 g, with 38 babies (78%) weighing more than 2,000 g. The mean birth weight percentile to gestational period was 54±23. Four babies (8.5%) had a birth weight percentile of less than 25, and 28 babies (59.6%) had a birth weight percentile greater than 50. Twelve patients demonstrated an increase in hepatic enzymes without jaundice during the pregnancy. All of them responded to augmentation of immunosuppression. Conclusion. The present report reconfirms the safety of tacrolimus during pregnancy after LTx. Preterm delivery and low birth weight seem to be a persistent problem in all solid-organ transplantation under any form of immunosuppression. However, toxemia of pregnancy and new onset of hypertension seem to be have a low occurrence with the use of tacrolimus.

Original languageEnglish (US)
Pages (from-to)827-832
Number of pages6
JournalTransplantation
Volume76
Issue number5
DOIs
StatePublished - Sep 15 2003

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Tacrolimus
Liver Transplantation
Immunosuppression
Birth Weight
Pregnancy
Mothers
Organ Transplantation
Liver
Alagille Syndrome
Transplants
Amenorrhea
Low Birth Weight Infant
Pre-Eclampsia
Jaundice
Cesarean Section
Cyclosporine
Uterus
Allografts
Liver Diseases
Chronic Disease

All Science Journal Classification (ASJC) codes

  • Transplantation

Cite this

Jain, Ashokkumar ; Reyes, J. ; Marcos, Amadeo ; Mazariegos, G. ; Eghtesad, Bijan ; Fontes, Paulo A. ; Cacciarelli, Thomas V. ; Marsh, J. Wallis ; De Vera, Michael E. ; Rafail, Ann ; Starzl, Thomas E. ; Fung, John J. / Pregnancy after liver transplantation with tacrolimus immunosuppression : A single center's experience update at 13 years. In: Transplantation. 2003 ; Vol. 76, No. 5. pp. 827-832.
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title = "Pregnancy after liver transplantation with tacrolimus immunosuppression: A single center's experience update at 13 years",
abstract = "Background. Chronic liver disease often leads to amenorrhea in women of childbearing age. There are several reports of successful pregnancy after liver transplantation (LTx) with cyclosporine A immunosuppression. Tacrolimus has been increasingly used in solid-organ transplantation, and the effect of the drug on pregnancy is still of interest to clinicians. This study updates our single-center experience. Methods. All pregnancies after LTx with tacrolimus immunosuppression were followed prospectively. Patients' clinical courses during pregnancy and labor along with gestational period and birth weight were catalogued. Changes in liver function, renal function, and immunosuppression also were recorded. The birth weight percentile was calculated on the basis of the gestational period using a standard chart. Results. Thirty-seven mothers delivered 49 babies. Three mothers delivered three times, and six mothers delivered two times. Thirty-six mothers (97{\%}) survived the pregnancy, and 36 allografts (97{\%}) survived. The one death and graft loss was in a patient who demonstrated infra-aortic arterial graft, which clotted by the gravid uterus during labor. The patient developed a gangrenous liver and died before she could undergo retransplantation. The mean gestational period was 36.4±3. 2 weeks, excluding two premature deliveries at 23 and 24 weeks gestation. Twenty-two babies (46.9{\%}) were delivered by cesarean section, and the other babies were delivered vaginally. In addition to the two premature babies, one baby, who was born to a mother with Alagille syndrome, died from congenital birth defects. The rest of the newborns survived. The mean birth weight was 2,797±775 g, with 38 babies (78{\%}) weighing more than 2,000 g. The mean birth weight percentile to gestational period was 54±23. Four babies (8.5{\%}) had a birth weight percentile of less than 25, and 28 babies (59.6{\%}) had a birth weight percentile greater than 50. Twelve patients demonstrated an increase in hepatic enzymes without jaundice during the pregnancy. All of them responded to augmentation of immunosuppression. Conclusion. The present report reconfirms the safety of tacrolimus during pregnancy after LTx. Preterm delivery and low birth weight seem to be a persistent problem in all solid-organ transplantation under any form of immunosuppression. However, toxemia of pregnancy and new onset of hypertension seem to be have a low occurrence with the use of tacrolimus.",
author = "Ashokkumar Jain and J. Reyes and Amadeo Marcos and G. Mazariegos and Bijan Eghtesad and Fontes, {Paulo A.} and Cacciarelli, {Thomas V.} and Marsh, {J. Wallis} and {De Vera}, {Michael E.} and Ann Rafail and Starzl, {Thomas E.} and Fung, {John J.}",
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language = "English (US)",
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Jain, A, Reyes, J, Marcos, A, Mazariegos, G, Eghtesad, B, Fontes, PA, Cacciarelli, TV, Marsh, JW, De Vera, ME, Rafail, A, Starzl, TE & Fung, JJ 2003, 'Pregnancy after liver transplantation with tacrolimus immunosuppression: A single center's experience update at 13 years', Transplantation, vol. 76, no. 5, pp. 827-832. https://doi.org/10.1097/01.TP.0000084823.89528.89

Pregnancy after liver transplantation with tacrolimus immunosuppression : A single center's experience update at 13 years. / Jain, Ashokkumar; Reyes, J.; Marcos, Amadeo; Mazariegos, G.; Eghtesad, Bijan; Fontes, Paulo A.; Cacciarelli, Thomas V.; Marsh, J. Wallis; De Vera, Michael E.; Rafail, Ann; Starzl, Thomas E.; Fung, John J.

In: Transplantation, Vol. 76, No. 5, 15.09.2003, p. 827-832.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Pregnancy after liver transplantation with tacrolimus immunosuppression

T2 - A single center's experience update at 13 years

AU - Jain, Ashokkumar

AU - Reyes, J.

AU - Marcos, Amadeo

AU - Mazariegos, G.

AU - Eghtesad, Bijan

AU - Fontes, Paulo A.

AU - Cacciarelli, Thomas V.

AU - Marsh, J. Wallis

AU - De Vera, Michael E.

AU - Rafail, Ann

AU - Starzl, Thomas E.

AU - Fung, John J.

PY - 2003/9/15

Y1 - 2003/9/15

N2 - Background. Chronic liver disease often leads to amenorrhea in women of childbearing age. There are several reports of successful pregnancy after liver transplantation (LTx) with cyclosporine A immunosuppression. Tacrolimus has been increasingly used in solid-organ transplantation, and the effect of the drug on pregnancy is still of interest to clinicians. This study updates our single-center experience. Methods. All pregnancies after LTx with tacrolimus immunosuppression were followed prospectively. Patients' clinical courses during pregnancy and labor along with gestational period and birth weight were catalogued. Changes in liver function, renal function, and immunosuppression also were recorded. The birth weight percentile was calculated on the basis of the gestational period using a standard chart. Results. Thirty-seven mothers delivered 49 babies. Three mothers delivered three times, and six mothers delivered two times. Thirty-six mothers (97%) survived the pregnancy, and 36 allografts (97%) survived. The one death and graft loss was in a patient who demonstrated infra-aortic arterial graft, which clotted by the gravid uterus during labor. The patient developed a gangrenous liver and died before she could undergo retransplantation. The mean gestational period was 36.4±3. 2 weeks, excluding two premature deliveries at 23 and 24 weeks gestation. Twenty-two babies (46.9%) were delivered by cesarean section, and the other babies were delivered vaginally. In addition to the two premature babies, one baby, who was born to a mother with Alagille syndrome, died from congenital birth defects. The rest of the newborns survived. The mean birth weight was 2,797±775 g, with 38 babies (78%) weighing more than 2,000 g. The mean birth weight percentile to gestational period was 54±23. Four babies (8.5%) had a birth weight percentile of less than 25, and 28 babies (59.6%) had a birth weight percentile greater than 50. Twelve patients demonstrated an increase in hepatic enzymes without jaundice during the pregnancy. All of them responded to augmentation of immunosuppression. Conclusion. The present report reconfirms the safety of tacrolimus during pregnancy after LTx. Preterm delivery and low birth weight seem to be a persistent problem in all solid-organ transplantation under any form of immunosuppression. However, toxemia of pregnancy and new onset of hypertension seem to be have a low occurrence with the use of tacrolimus.

AB - Background. Chronic liver disease often leads to amenorrhea in women of childbearing age. There are several reports of successful pregnancy after liver transplantation (LTx) with cyclosporine A immunosuppression. Tacrolimus has been increasingly used in solid-organ transplantation, and the effect of the drug on pregnancy is still of interest to clinicians. This study updates our single-center experience. Methods. All pregnancies after LTx with tacrolimus immunosuppression were followed prospectively. Patients' clinical courses during pregnancy and labor along with gestational period and birth weight were catalogued. Changes in liver function, renal function, and immunosuppression also were recorded. The birth weight percentile was calculated on the basis of the gestational period using a standard chart. Results. Thirty-seven mothers delivered 49 babies. Three mothers delivered three times, and six mothers delivered two times. Thirty-six mothers (97%) survived the pregnancy, and 36 allografts (97%) survived. The one death and graft loss was in a patient who demonstrated infra-aortic arterial graft, which clotted by the gravid uterus during labor. The patient developed a gangrenous liver and died before she could undergo retransplantation. The mean gestational period was 36.4±3. 2 weeks, excluding two premature deliveries at 23 and 24 weeks gestation. Twenty-two babies (46.9%) were delivered by cesarean section, and the other babies were delivered vaginally. In addition to the two premature babies, one baby, who was born to a mother with Alagille syndrome, died from congenital birth defects. The rest of the newborns survived. The mean birth weight was 2,797±775 g, with 38 babies (78%) weighing more than 2,000 g. The mean birth weight percentile to gestational period was 54±23. Four babies (8.5%) had a birth weight percentile of less than 25, and 28 babies (59.6%) had a birth weight percentile greater than 50. Twelve patients demonstrated an increase in hepatic enzymes without jaundice during the pregnancy. All of them responded to augmentation of immunosuppression. Conclusion. The present report reconfirms the safety of tacrolimus during pregnancy after LTx. Preterm delivery and low birth weight seem to be a persistent problem in all solid-organ transplantation under any form of immunosuppression. However, toxemia of pregnancy and new onset of hypertension seem to be have a low occurrence with the use of tacrolimus.

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