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Pregnancy in cardiac transplant recipients
Author(s) -
Bhagra Catriona J.,
Bhagra Sai K.,
Donado Alicia,
Butt Tanveer,
Forrest Lindsey,
MacGowan Guy A.,
Parry Gareth
Publication year - 2016
Publication title -
clinical transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 76
eISSN - 1399-0012
pISSN - 0902-0063
DOI - 10.1111/ctr.12788
Subject(s) - medicine , pregnancy , preeclampsia , calcineurin , tacrolimus , transplantation , creatinine , fetus , renal function , obstetrics , surgery , genetics , biology
Purpose Successful pregnancy following cardiac transplantation has been described, although outcome data from individual centers are relatively sparse. We investigated maternal and fetal outcomes including change in left ventricular ( LV ) function and calcineurin inhibitor ( CNI ) dose in women who became pregnant from our institution. Methods We identified every female patient <49 years at the time of transplant who survived >3 months post‐surgery, between 1985 and 2014. Those who conceived had a review of their medical records and transplant charts. Those currently alive were interviewed. Results There were 22 pregnancies in 17 women with 20 live births (91%). Mean time from transplantation was 98±62.4 months. Rejection complicated one pregnancy, and LV function remained normal in all others. Hypertension complicated 3 (13.6%), preeclampsia 3 (13.6%), and cholestasis 1 (4.5%). Mean birthweight was 2447±608 grams at 34.1±3.6 weeks. Four women died following pregnancy. A significant increase in total daily dose of tacrolimus and cyclosporine A was required to maintain therapeutic levels through pregnancy (CyA, P <.001; and Tac, P =.001), with no deterioration in serum creatinine. Conclusions We report a 91% live birth rate post‐cardiac transplantation. Meticulous individualized care with frequent monitoring of CNI levels and LV function is necessary to optimize the maternal and fetal outcomes.