Congenital Infections in Neonates of Women With Liver or Kidney Transplants

Kociszewska-Najman, Bozena; Pietrzak, Bronisława; Czaplinska, Natalia; Cyganek, Anna; Jabiry-Zieniewicz, Zoulikha; Schreiber-Zamora, Joanna; Drozdowska-Szymczak, Agnieszka; Bobrowska, Katarzyna; Wielgoś, Mirosław

doi:10.1016/j.transproceed.2016.01.088

Cited by 9 publications

(7 citation statements)

References 31 publications

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“…A very recent retrospective analysis of 71 neonates born to transplant recipients (liver and kidney) showed no difference compared to general population. 23 Nevertheless, the risk of a clinically important primary or secondary CMV infection is increased in newborns of transplant recipients, especially in high-risk constellations (donor CMV positive/recipient CMV negative). Around one-third (30-39%) of primary CMV infections during pregnancy are transferred to the fetus and up to 13% of these cases results in a symptomatic congenital CMV infection in the newborn.…”

Section: Congenital Infectionsmentioning

confidence: 99%

Pregnancy After Renal Transplantation

Chittka

Hutchinson²

2017

Transplantation

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editing in which organogenesis has been disabled. This created an environment facilitating the enrichment of rat pluripotent stem cell derivatives in the tissues of mice. However, naïve rodent pluripotent stem cells were not found to be able to contribute to chimera formation in pigs. Moving to human pluripotent stem cells, the authors show that these cells were able to engraft in pig and cattle preimplantation blastocysts, although they did not contribute significantly to the postimplantation embryos and thus did not form efficient chimeras. Culturing of the human stem cells under specific conditions, the authors were able to create an intermediate pluripotent stem cell type, which interestingly resulted in higher levels of chimerism and progeny development in postimplantation pig embryos. Whether this degree of chimerism results in successful human-pig blastocyst complementation and subsequent organ development is not yet clear. Although promising, the approach is still considerably inefficient, and further work will need to address methods for creating a selective advantage for human pluripotent stem cells in recipient species.

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Section: Congenital Infectionsmentioning

confidence: 99%

Pregnancy After Renal Transplantation

Chittka

Hutchinson²

2017

Transplantation

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“…66 Drozdowska-Szymczak et al observed no significant differences in immunoglobulin concentrations at birth between infants born to mothers on Tac treatment after SOT and those born to healthy mothers. 67,68 Kociszewska-Najman et al 69 reported that white blood cell counts within the first 72 hours after birth were within the normal limits.…”

Section: Immunological Outcomesmentioning

confidence: 99%

“…The rates of infections also did not differ significantly between Tac plus corticosteroid treatment (23.9%), CsA plus corticosteroid treatment (13.6%), and AZA plus corticosteroid and CNI treatment (26.9%). 69…”

Section: Immunological Outcomesmentioning

confidence: 99%

Usage of Tacrolimus and Mycophenolic Acid During Conception, Pregnancy, and Lactation, and Its Implications for Therapeutic Drug Monitoring: A Systematic Critical Review

Le¹,

Francke

Andrews

et al. 2020

Therapeutic Drug Monitoring

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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, 2019) using Ovid MEDLINE, EMBASE, the Cochrane Central Register of controlled trials, Google Scholar, and Web of Science, and 102 studies were included. Another 60 were included from the reference list of the published articles. Results: As MPA is teratogenic, women who are trying to conceive are strongly recommended to switch from MPA to azathioprine. MPA treatment in men during conception seems to have no adverse effect on pregnancy outcomes. Nevertheless, in 2015, the drug label was updated with additional risk minimization measures in a pregnancy prevention program. Data on MPA pharmacokinetics during pregnancy and lactation are limited. Tac treatment during conception, pregnancy, and lactation seems to be safe in terms of the health of the mother, (unborn) child, and allograft. However, Tac may increase the risk of hypertension, preeclampsia, preterm birth, and low birth weight. Infants will ingest very small amounts of Tac via breast milk from mothers treated with Tac. However, no adverse outcomes have been reported in children exposed to Tac during lactation. During pregnancy, changes in Tac pharmacokinetics result in increased unbound to whole-blood Tac concentration ratio. To maintain Tac concentrations within the target range, increased Tac dose and intensified TDM may be required. However, it is unclear if dose adjustments during pregnancy are necessary, considering the higher concentration of (active) unbound Tac. Conclusions: Tac treatment during conception, pregnancy and lactation seems to be relatively safe. Due to pharmacokinetic changes during pregnancy, a higher Tac dose might be indicated to maintain target concentrations. However, more evidence is needed to make recommendations on both Tac dose adjustments and alternative matrices than whole-blood for TDM of Tac during pregnancy. MPA treatment in men during conception seems to have no adverse effect on pregnancy outcomes, whereas MPA use in women during conception and pregnancy is strongly discouraged.

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“…Zalecany schemat leczenia immunosupresyjnego pacjentek ciężarnych po przeszczepieniu nerki wg badania przeprowadzonego przez Kociszewska--Najman obejmuje takrolimus [24]. Cyklosporynę podawano u około 30% ciężarnych, zarówno [25].…”

Section: Przeszczepione Narządy Miąższoweunclassified

“…Częstość zakażeń wrodzonych u noworodków biorców alogenicznych nie jest znacznie wyższa niż w ogólnej populacji. Schematy immunosupresyjne z azatiopryną wydają się być obarczone największym ryzykiem, nieco bezpieczniejszy wydaje się być schemat z takrolimusem oraz schematy oparte na cyklosporynie [24].…”

Section: Przeszczepione Narządy Miąższoweunclassified