FK 506 and Successful Pregnancy in a Patient After Renal Transplantation

Resch, B; Mache, Christoph J.; Windhager, Thomas; Holzer, Herwig; Leitner, G.; Müller, Wilhelm

doi:10.1016/s0041-1345(97)01220-7

Cited by 12 publications

(11 citation statements)

References 7 publications

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“…However, tacrolimus has been reported to cause reversible neonatal hyperkalemia and renal impairment (1). In addition, intrauterine growth restriction as well as premature delivery due to hypertension, preeclampsia and premature rupture of membranes have been reported (1, 47, 76, 77). The long-term effects of in utero exposure to tacrolimus are not known, but the usual well-known complications from prematurity and/or low birth weight are expected to be observed in the infant when part of the clinical picture.…”

Section: Fetal Exposurementioning

confidence: 99%

Interpreting Tacrolimus Concentrations During Pregnancy and Postpartum

et al. 2013

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Summary Pregnancy following solid organ transplantation, although considered high risk for maternal, fetal and neonatal complications, has been quite successful. Tacrolimus pharmacokinetic changes during pregnancy make interpretation of whole blood trough concentrations particularly challenging. There are multiple factors that can increase the fraction of unbound tacrolimus, including but not limited to low albumin concentration and low RBC count. The clinical titration of dosage to maintain whole blood tacrolimus trough concentrations in the usual therapeutic range can lead to elevated unbound concentrations and possibly toxicity in pregnant women with anemia and hypoalbuminemia. Measurement of plasma or unbound tacrolimus concentrations for pregnant women might better reflect the active form of the drug, though these are technically-challenging and often unavailable in usual clinical practice. Tacrolimus crosses the placenta with in utero exposure being approximately 71% of maternal blood concentrations. The lower fetal blood concentrations are likely due to active efflux transport of tacrolimus from the fetus toward the mother by placental P-glycoprotein. To date, tacrolimus has not been linked to congenital malformations, but can cause reversible nephrotoxicity and hyperkalemia in the newborn. In contrast, very small amounts of tacrolimus are excreted in the breast milk and are unlikely to elicit adverse effects in the nursing infant.

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Section: Fetal Exposurementioning

confidence: 99%

Interpreting Tacrolimus Concentrations During Pregnancy and Postpartum

et al. 2013

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“…Hypertension is the most-frequent maternal complication, being recorded in 15%-64% of pregnant women administered IS agents, especially CsA and tacrolimus [13,25]. The shorter the delay between transplantation and pregnancy, the higher the incidence of hypertension: of hypertensive pregnant women had a delay of less than 2 years between transplantation and pregnancy [26].…”

Section: Complications In Pregnant Women Administered Immunosuppressimentioning

confidence: 99%

“…This condition may promote a placental insufficiency [25]. Proteinuria was particularly observed in women treated with tacrolimus (30%-40%) [22,27].…”

Section: Complications In Pregnant Women Administered Immunosuppressimentioning

confidence: 99%

See 1 more Smart Citation

In utero exposure to immunosuppressive drugs: experimental and clinical studies

Tendron¹,

Jb²,

Decramer³

2002

Pediatric Nephrology

101

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Over the last few decades, the number of pregnant women under immunosuppressive (IS) therapy following transplantation or autoimmune diseases has increased. At first, IS drugs, including prednisone, azathioprine, and cyclosporine A were used, but now new molecules such as tacrolimus and mycophenolate mofetil have appeared. These IS drugs cross the placental barrier and enter into the fetal circulation, which poses a risk for fetal development. Experimental data have shown that IS drugs often have deleterious effects on fetuses, while human data have reported an increased rate of abortion, prematurity, intrauterine growth retardation (IUGR), and low birth weight, without significant increases in malformation rates. However, only limited information is available about the newly used molecules. Although fetal and neonatal data are reassuring, long-term effects of IS drugs on fertility, immune response and renal function, as well as the consequences of prematurity and IUGR, should be monitored.

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“…Neonatal hyperkalemia, low birth weight, and premature delivery have also been reported among women who were treated with tacrolimus during pregnancy. 53,[58][59][60][61] It is unclear whether the observed teratogenic effects are a result of the patient's transplantation status or the medication itself. The women in these studies had serious medical problems and received a number of other medications that could have affected fetal development.…”

Section: Corticosteroidsmentioning

confidence: 99%