Immunosuppressive Therapy and Breast-Feeding after Renal Transplantation

Dimitrios M. Grekas, MD, Renal Unit, 1st Medical Department, University of Thessaloniki, Thessaloniki (Greece) Pregnancy in the renal transplant population now seems to be relatively safe when renal function is adequate before conception and when maintenance immunosuppressive therapy is instituted [1]. All patients receiving renal allografts at our department are given immunosuppressive agents, azathioprine and methylprednisolone. Although breast-feeding in these patients has been discouraged because of the potential risk to the infant from the immunosuppressive drugs, 2 of them chose to breast-feed their infants. It is widely accepted that human milk has the potential to afford a baby significant protection against a range of infections, particularly of the respiratory and gastrointestinal tracts [2]. The precise way in which breast milk achieves its antibacterial and antiviral properties is not well known, but it does contain a wide range of protective factors, including immunoglobulins, complement components and different types of cells with phagocytic capacities [3]. Of the immunoglobulins, secretory IgA is the most important. In a recent publication [4], the IgA level in the breast milk of a patient taking immunosuppressive drugs was found to be similar to that in the controls. Also, there is no evidence so far that immunosuppression can occur from the small amount of azathioprine (6-mercapto-purine) or methylprednisolone found in the breast milk of transplanted mothers who are under the lower maintenance dose of immunosuppressive drugs during gestation and lactation. In our 2 cases, immunosuppressive drugs as well as breast milk IgA levels were not determined, but the infants described herein (table I) have normal blood cell counts, no increase in infections and above-average growth rate. References Rudolph, J.E.; Schweizer, R.T.; Bartus, S.A.: Pregnancy in renal transplantation. Transplantation 27: 26 (1979). Editorial: The how of brest milk and infection. Lancet i: 1192 (1981). Whitehead, R.G.: Nutritional aspects of human lactation. Lancet i: 167 (1983). Coulam, C.B.; Moyer, T.P.; Jiang, N.S.; et al.: Breast-feeding after renal transplantation. Transplant. Proc. 13: 605 (1982). Table I. Report of cases Patient 1 Patient 2 Past history Primary disease chronicreflux glomerulonephropathy nephritisDonor source mother mother