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Pregnancy after liver transplantation under tacrolimus

Jain, A and Venkataramanan, R and Fung, JJ and Carlton Gartner, J and Lever, J and Balan, V and Warty, V and Starzl, TE (1997) Pregnancy after liver transplantation under tacrolimus. Transplantation, 64 (4). 559 - 565. ISSN 0041-1337

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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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Details

Item Type: Article
Status: Published
Creators/Authors:
CreatorsEmailPitt UsernameORCID
Jain, A
Venkataramanan, Rrv@pitt.eduRV
Fung, JJ
Carlton Gartner, J
Lever, J
Balan, V
Warty, V
Starzl, TEtes11@pitt.eduTES11
Centers: Other Centers, Institutes, or Units > Thomas E. Starzl Transplantation Institute
Date: 27 August 1997
Date Type: Publication
Journal or Publication Title: Transplantation
Volume: 64
Number: 4
Page Range: 559 - 565
DOI or Unique Handle: 10.1097/00007890-199708270-00002
Institution: University of Pittsburgh
Refereed: Yes
ISSN: 0041-1337
Other ID: uls-drl:31735062127059, Starzl CV No. 1983
Date Deposited: 08 Apr 2010 17:33
Last Modified: 13 Oct 2017 22:55
URI: http://d-scholarship.pitt.edu/id/eprint/5369

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