Pregnancy in heart transplant recipients

Miniero, R; Tardivo, Irene; Centofanti, Paolo; Goggi, C.; Mammana, Carmelo; Parisi, Francesco; Dall’Omo, Anna Maria

doi:10.1016/j.healun.2003.08.002

Cited by 24 publications

(17 citation statements)

References 28 publications

(29 reference statements)

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“…While our study suggests poorer prognosis in the cardiothoracic group compared to our liver recipients, our cohort also had the lowest mean gestational age (35.5 weeks) and lowest mean birthweight (2441 g) when compared to the other cardiothoracic recipients in the literature (range 36.4–38.3 weeks, range 2600–2143 g) [6], [15]–[17]. As a national, prospective study we would expect our data to be less subject to selection bias and reporting bias inherent in single-centre studies and voluntary registries.…”

Section: Discussioncontrasting

confidence: 50%

“…While the majority (60%) of our cohort breastfed their infants and current international consensus suggests it should not be viewed as absolutely contraindicated [5], the topic remains controversial and many centres advocate avoidance to their patients [15], [17]. Recent evidence suggests that tacrolimus therapy should not be a contraindication to breast feeding [34], [35].…”

Section: Discussionmentioning

confidence: 92%

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Pregnancy Outcomes in Liver and Cardiothoracic Transplant Recipients: A UK National Cohort Study

et al. 2014

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IntroductionThere are an increasing number of reports of pregnancy in transplant recipients but many questions remain regarding the effect of the transplant on pregnancy outcome, the pregnancy on the graft and the medication on the fetus. The majority of studies reporting outcomes in transplant recipients have focused on women with kidney transplants, and have included retrospective, voluntary registries or single centre studies.MethodsThe UK Obstetric Surveillance System (UKOSS) was used to prospectively identify all pregnant women with a liver or cardiothoracic transplant in the United Kingdom, between January 2007 and January 2012. Data were collected on demographics, transplant characteristics, immunosuppression regimens, antenatal care, maternal, graft and neonatal outcomes. In an exploratory analysis, we tested for associations between “poor fetal outcome” and medications used before or during pregnancy.Results and conclusionsWe report 62 pregnancies in 56 liver transplant recipients and 14 pregnancies in 14 cardiothoracic transplant recipients (including 10 heart, three lung and one heart-lung recipient). Liver transplant recipients, in comparison to cardiothoracic, had similar livebirth rates (92% vs. 87%) but better fetal outcomes (median gestational age 38 weeks vs. 35 weeks; median birthweight 2698 g vs. 2365 g), fewer caesarean deliveries (47% vs. 62%), fewer maternal intensive care (ICU) admissions (19% vs. 29%) and fewer neonatal ICU admissions (25% vs. 54%). Nine women (12%) were taking mycophenolate mofetil at conception, which was associated with adverse fetal outcomes. Pregnancy in transplant recipients may have successful outcomes, but complication rates are high, emphasising the role of pre-conception counselling and further research into the long-term effect on maternal and graft survival rates.

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Section: Discussioncontrasting

confidence: 50%

Section: Discussionmentioning

confidence: 92%

Pregnancy Outcomes in Liver and Cardiothoracic Transplant Recipients: A UK National Cohort Study

et al. 2014

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“…They also showed that a 20%–25% dose increase in CNIs should be expected during the gestational period . In cardiac patients, there are less conclusive data in this field, with conflicting reports on dose adjustments throughout the literature …”

Section: Discussionmentioning

confidence: 99%

“…36 In cardiac patients, there are less conclusive data in this field, with conflicting reports on dose adjustments throughout the literature. 6,10,37 All immunosuppressive agents cross the placenta with the potential for teratogenic effects. No congenital cardiac or other anomalies were reported among the offspring in our group.…”

Section: Preconceptionmentioning

confidence: 99%

“…The United Kingdom (UK) transplant pregnancy registry which was established in 1997 ceased to collect data in 2001. 4 Although several series have reported pregnancy outcomes in both single-and multicenter settings, [5][6][7][8][9][10] there is a paucity of outcome data from individual centers within the UK. Our center is one of only two within the UK performing pediatric cardiac transplantation, and transplantation in children and adults with complex congenital heart disease.…”

Section: Introductionmentioning

confidence: 99%

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