FK506 AND PREGNANCY IN LIVER TRANSPLANT PATIENTS

There have been several reports of successful pregnancy in organ transplant patients treated with AZA, steroids, or CsA (1,2). However, the use of these immunosuppressive drugs in renal transplant patients is often associated with preeclampsia, preterm births, and severe intrauterine growth retardation (1). Earlier. we have reported pregnancy in liver transplant patients treated with AZA or CsA at the University of Pittsburgh Medical Center (3). In the present communication, we summarize our recent experience with pregnancy in liver transplant patients treated with FK506 as the primary immunosuppressive drug. At the present time, there are 876 males and 627 female liver transplant patients on FK506 immunosuppression at the University of Pittsburgh Medical Center. Nine pregnancies have been recorded in 9 of these patients on FK506 therapy. These patients received liver transplantation for Caroli's disease (1), primary biliary cirrhosis (1), alcoholic cirrhosis (2), cryptogenic cirrhosis (2), fulminant hepatic failure (1), autoimmune hepatitis (1), or non-A non-B hepatitis (1). The age of the mothers ranged from 18 to 35 years. Four of them were primary FK506 patients and 5 of them were switched to FK506 therapy after chronic rejection while on CsA. All of the patients received FK506 with (n=5) or without steroid (n=4) therapy during the entire period of pregnancy. The FK506 doses ranged from 2 mg qd to 32 mg bid. Two patients had mild hypertension and 1 had proteinurea during pregnancy. Six of the 9 patients had normal vaginal delivery; 3 patients required cesarean section for previous classical cesarean section, placenta abruptio, or antepartum hemorrhage. All the patients had normal liver function before pregnancy, and 2 patients who experienced an episode of rejection during pregnancy were treated successfully with high-dose steroids. Table 1 lists the clinical data on the patients and the infants born. None of the babies was considered small for gestational age, based on the Colorado intrauterine Growth Charts (4). Table 1 Clinical Data in Pregnancies Occurring in Liver Transplant Recipients Treated with FK506 Five of the 7 babies for whom potassium levels were available had hyperkalemia (range 6.1–10.9 mEq/L) at the time of birth that resolved spontaneously within 24–48 hr without any treatment. One baby who was delivered by a patient known to be a cocaine addict was hypoxic, tested positive for cocaine, remained in the incubator for 2 weeks, but recovered after that time period. One baby who was born to a mother with renal impairment during pregnancy was anuric for 36 hr, secondary to high FK506 concentrations in the cord, but regained normal renal function in 1 week. The only baby that died 2 hr after birth was born prematurely (22 weeks) to a 20-year-old patient who conceived within a month after transplantation. This patient had evidence of CMV in the blood and gastrointestinal tract and was treated with ganciclovir. Eight of the 9 babies are currently alive and are developing normally. In conclusion, liver transplant patients on FK506 appear to have a normal course of pregnancy and, in the majority of cases, give birth to normal and healthy babies.