tacrolimus and Infant--Newborn--Diseases

Topics: Breast Feeding; Calcineurin Inhibitors; Cyclosporine; Female; Humans; Immunosuppressive Agents; Infant, Newborn; Infant, Newborn, Diseases; Kidney Transplantation; Pregnancy; Tacrolimus

Women who have undergone liver transplantation (LT) enjoy better health, and possibility of childbearing. However, maternal and graft risks, optimal immunosuppression, and fetal outcome is still to clarify.. Aim of the study was to assess outcomes of pregnancy after LT at national level.. In 2019, under the auspices of the Permanent Transplant Committee of the Italian Association for the Study of the Liver, a multicenter survey including 14 Italian LT-centers was conducted aiming at evaluating the outcomes of recipients and newborns, and graft injury/function parameters during pregnancy in LT-recipients.. Sixty-two pregnancies occurred in 60 LT-recipients between 1990 and 2018. Median age at the time of pregnancy was 31-years and median time from transplantation to conception was 8-years. During pregnancy, 4 recipients experienced maternal complications with hospital admission. Live-birth-rate was 100%. Prematurity occurred in 25/62 newborns, and 8/62 newborns had low-birth-weight. Cyclosporine was used in 16 and Tacrolimus in 37 pregnancies, with no different maternal or newborn outcomes. Low-birth-weight was correlated to high values of AST, ALT and GGT.. Pregnancy after LT has good outcome; however, maternal complications and prematurity may occur. Compliance with the immunosuppression is fundamental to ensure the stability of graft function and prevent graft-deterioration.

Topics: Cyclosporine; Female; Humans; Immunosuppressive Agents; Infant, Newborn; Infant, Newborn, Diseases; Liver Transplantation; Pregnancy; Pregnancy Complications; Pregnancy Outcome; Tacrolimus

Successful pregnancy after transplantation has become more common and more recipients are choosing to breastfeed their infants, despite the controversy surrounding the safety of breastfeeding while the mother is taking immunosuppressive medications, such as tacrolimus. Data collected to date by the National Transplantation Pregnancy Registry have not revealed specific problems related to breastfeeding; however, individual circumstances must be considered when counseling transplant recipients regarding breastfeeding. Bramham et al. reported on a series of transplant recipients who were maintained on tacrolimus during pregnancy and lactation and concluded that women should not be discouraged from breastfeeding while on tacrolimus. Recently, other authors have also supported the option of breastfeeding while recipients are maintained on tacrolimus. Herein, we review the Bramham article and discuss the key issues to be considered regarding the compatibility of breastfeeding and immunosuppression.

Topics: Bottle Feeding; Breast Feeding; Female; Humans; Infant, Newborn, Diseases; Pregnancy; Pregnancy Complications; Tacrolimus

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.. 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.. 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 1.3 μg/L [range, 0.0-4.0] versus 1.0 μg/L [range, 0.0-2.3], respectively; P=0.91). Maximum estimated absorption from breast milk is 0.23% of maternal dose (weight-adjusted).. 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.

Topics: Adult; Bottle Feeding; Breast Feeding; Cohort Studies; Female; Humans; Immunosuppression Therapy; Immunosuppressive Agents; Infant; Infant, Newborn; Infant, Newborn, Diseases; Lactation; Milk, Human; Pregnancy; Pregnancy Complications; Risk Factors; Tacrolimus