Education Corner – Can Someone with a Transplant Become Pregnant?

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The first known post-transplant pregnancy occurred in 1958 in a recipient who had received a kidney from her identical twin sister. Successful post-transplant pregnancies have since been reported among recipients of all types of solid organ transplants.

In 1991, a resource for transplant recipients and their healthcare providers was established by Drs. Vincent Armenti and Michael Moritz at Thomas Jefferson University in Philadelphia, through the creation of the National Transplantation Pregnancy Registry.

NTPR Reported Pregnancy Outcome Data

2,703 Pregnancies in Female Transplant Recipients (as of Dec 2015)
1,390 Pregnancies Fathered by Male Recipients (as of Dec 2015
PregnancyStats

**Mycophenolic acid and mycophenolate mofetil, two commonly prescribed immunosuppressive medications, should be avoided whenever possible during pregnancy.**

Breastfeeding
  • Recent studies show that prednisone, azathioprine, cyclosporine and tacrolimus use by recipients need not discourage breastfeeding.
  • There are only limited data on breastfeeding safety for recipients taking mycophenolic acid products, sirolimus, everolimus and belatacept.
  • Testing serum and breast milk can be undertaken to address concerns about infant exposure through breast milk to immunosuppression medications.
Factors to consider in the timing of pregnancy (AST, 2005):
  • No rejection in the past year
  • Adequate and stable graft function
  • No acute infections that impact fetus
  • Maintenance immunosuppression at stable dosing
Management Options:

ManagementPregnancy

 

Taken from a webinar presentation by Lisa A. Coscia, RN, BSN, CCTC from the National Transplantation Pregnancy Registry, Gift of Life Institute,  Philadelphia, PA. A special thanks to Lisa for her contributions in this inservice.

The webinar presentation is available through the Alliance Academy: https://organdonationalliance.org/alliance-academy/

The NTPR is now at the Gift of Life Institute in Philadelphia. The NTPR welcomes inquiries at 877-955-6877 or ntpr@giftoflifeinstitute.org.

References:
Murray JE, Reid DE, Harrison JH, Merrill JP Successful pregnancies after human renal transplantation. N Engl J Med;1963 269: 34.
National Transplantation Pregnancy Registry (NTPR) 2014 Annual Report Gift of Life Institute, Philadelphia;2015
Coscia LA, Constantinescu S, Armenti DP, Moritz MJ. Report from the National Transplantation Pregnancy Registry (NTPR): Outcomes of Pregnancy after Transplantation.  In: Clinical Transplants 2015.  Eds: Everly M and Terasaki P, Terasaki Foundation Laboratory, Los Angeles, CA, 57-68, 2016
Bramham K, Chusney G, Lee J, et al. Breastfeeding and tacrolimus: serial monitoring in breast-fed and bottle-fed infants. Clin J Am Soc Nephrol. 2013;8(4):563.
Constantinescu S, Pai A, Coscia LA, et al. Breast-feeding after transplantation. Best Pract Res Clin Obstet Gynaecol 2014;28(8):1163.
Coscia LA, Armenti DP, King RW, et al.  Update on the teratogenicity of maternal mycophenolate mofetil. J Pediatr Genet 2014;4(2):42.
Perez-Aytes A, Ledo A, Boso V, Sáenz P, Roma E, Poveda JL, et al. In utero exposure to mycophenolate mofetil: A characteristic phenotype? Am J Med Genet Part A 2008;146A:1.
Jackson P, Paquette L, Watiker V, Randolph L, Ramanathan R, Seri I. Intrauterine exposure to mycophenolate mofetil and multiple congenital anomalies in a newborn: possible teratogenic effect. Am J of Med Genet Part A 2009;149A:1231.
Sifontis NM, Lundgren MP, Constantinescu S, et al. Pregnancies after Transplantation with Exposure to Mycophenolic Acid Products. Am J Transplant 2012;12(3):154.
Sifontis NM, Coscia LA, Armenti DP, Constantinescu S, Moritz MJ.  Pregnancy Outcomes in Solid   Organ Transplant Recipients with Exposure to Sirolimus without Mycophenolate. Am J Transplant 2015;15(S3):A#45.
Jones A, Clary MJ, McDermott E, Coscia LA, et al.  Outcomes of pregnancies fathered by solid-organ transplant recipients exposed to mycophenolic acid products. Prog Transplant 2013;23(2):153
McKay DB, Josephson MA, Armenti VT, et al.  Women’s Health Committee of the American Society of Transplantation. Reproduction and transplantation: report on the AST Consensus Conference on Reproductive Issues and Transplantation. Am J Transplant 2005;5(7):1592.
Armenti VT, Moritz MJ, Davison JM.  Pregnancy Following Transplantation.  In: High Risk Pregnancy: Management Options, 3rd Edition.  James, D.K., Steer, P.J., Weiner, C.P., Gonik, B. (Eds).  Elsevier Science, Philadelphia, PA, 1174-1186, 2006

Editor: Hedi Aguiar RN, MSN, Director of Programs and Communications, The Alliance, haguiar@odt-alliance.org.
This Education Corner is available for download. The Alliance grants permission for the distribution and reproduction of this educational communication.

 

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