AASLD: Pregnancy Data Reassuring to Women with Liver Transplants

[Guest guest]

http://www.medpagetoday.com/MeetingCoverage/AASLD/11581

Medical News from

AASLD: American Association for the Study of Liver Diseases Meeting

AASLD: Pregnancy Data Reassuring to Women with Liver Transplants

By , North American Correspondent, MedPage Today

Published: November 03, 2008

Reviewed by Jasmer, MD; Associate Clinical Professor of Medicine,

University of California, San Francisco Earn CME/CE credit

for reading medical news

SAN FRANCISCO, Nov. 3 -- Babies of women using immunosuppressants for liver

transplants have no excess risk of structural malformations because of the

drugs, a researcher said here. Action Points

--------------------------------------------------------------------------------

Explain to interested patients that because of the medications used to suppress

the immune system after a liver transplant, clinicians and patients had worried

that pregnancies could be risky.

Note that this study found that the risk of structural malformations in babies

born to women with a liver transplant is no higher than in the general

population.

Note that this study was published as an abstract and presented in poster form

at a conference. These data and conclusions should be considered to be

preliminary until published in a peer-reviewed journal.

Data from the National Transplantation Pregnancy Registry show the risk is no

higher that than seen in the general population, said Carlo , M.D., of

Jefferson University in Philadelphia, at the American Association for the

Study of Liver Diseases meeting.

But, he added, he would still counsel women to delay pregnancy until the

transplant is stable and liver function is normal.

Dr. and colleagues conducted interviews with 125 women and studied

medical records for their 218 pregnancy outcomes. All told, there were 161 live

births, 41 spontaneous abortions, 11 therapeutic abortions, four stillbirths and

one ectopic pregnancy.

On average, the women got pregnant 4.7 years after their transplant, the

researcher found.

Immunosuppression was cyclosporine-based in 143 pregnancies, tacrolimus-based in

63, and there was no immunosuppression in five. Mycophenolate mofetil (CellCept)

was used as adjunctive therapy in four pregnancies.

In the 161 live births, the data showed that the average gestational age was

36.7 weeks, with 37% of the babies premature. Average birthweight was 2,670

grams, and 35% of the babies were less than 2,500 grams.

Only six of the babies had structural malformations, including two cases of

pyloric stenosis, one hyperspadia, one ventricular septal defect, and one kidney

malformation. One newborn with multiple cardiac and central nervous system

defects subsequently died.

Overall, the rate of malformation was 3.7%, Dr. said. In comparison, the

rate of such malformations among the general population is generally considered

to be between 3% and 5%, he said.

" This is a very important study, " commented Arthur McCullough, M.D., of the

Cleveland Clinic, who is president of the liver association.

He said hepatologists have been concerned that the use of a range of medications

-- including steroids, immunosuppressants, and cytokines -- in women with liver

transplants could affect their chances of a healthy baby although there has been

little hard evidence of risk.

" These are drugs that we just worry about, " he said.

" Patients would come to us and say, 'I really want to get pregnant,' " but until

now clinicians could offer little guidance, he said.

The study had support from Novartis Pharmaceuticals, Astellas Pharma, Roche

Laboratories, and Wyeth Pharmaceuticals. Dr. said he had no conflicts.

Primary source: Hepatology

Source reference:

C, et al " Structural Birth Defects in the Newborn of Female Liver

Transplant Recipients " Hepatology 2008; 48(4): Abstract 544.

[Guest guest]

http://www.medpagetoday.com/MeetingCoverage/AASLD/11581

Medical News from

AASLD: American Association for the Study of Liver Diseases Meeting

AASLD: Pregnancy Data Reassuring to Women with Liver Transplants

By , North American Correspondent, MedPage Today

Published: November 03, 2008

Reviewed by Jasmer, MD; Associate Clinical Professor of Medicine,

University of California, San Francisco Earn CME/CE credit

for reading medical news

SAN FRANCISCO, Nov. 3 -- Babies of women using immunosuppressants for liver

transplants have no excess risk of structural malformations because of the

drugs, a researcher said here. Action Points

--------------------------------------------------------------------------------

Explain to interested patients that because of the medications used to suppress

the immune system after a liver transplant, clinicians and patients had worried

that pregnancies could be risky.

Note that this study found that the risk of structural malformations in babies

born to women with a liver transplant is no higher than in the general

population.

Note that this study was published as an abstract and presented in poster form

at a conference. These data and conclusions should be considered to be

preliminary until published in a peer-reviewed journal.

Data from the National Transplantation Pregnancy Registry show the risk is no

higher that than seen in the general population, said Carlo , M.D., of

Jefferson University in Philadelphia, at the American Association for the

Study of Liver Diseases meeting.

But, he added, he would still counsel women to delay pregnancy until the

transplant is stable and liver function is normal.

Dr. and colleagues conducted interviews with 125 women and studied

medical records for their 218 pregnancy outcomes. All told, there were 161 live

births, 41 spontaneous abortions, 11 therapeutic abortions, four stillbirths and

one ectopic pregnancy.

On average, the women got pregnant 4.7 years after their transplant, the

researcher found.

Immunosuppression was cyclosporine-based in 143 pregnancies, tacrolimus-based in

63, and there was no immunosuppression in five. Mycophenolate mofetil (CellCept)

was used as adjunctive therapy in four pregnancies.

In the 161 live births, the data showed that the average gestational age was

36.7 weeks, with 37% of the babies premature. Average birthweight was 2,670

grams, and 35% of the babies were less than 2,500 grams.

Only six of the babies had structural malformations, including two cases of

pyloric stenosis, one hyperspadia, one ventricular septal defect, and one kidney

malformation. One newborn with multiple cardiac and central nervous system

defects subsequently died.

Overall, the rate of malformation was 3.7%, Dr. said. In comparison, the

rate of such malformations among the general population is generally considered

to be between 3% and 5%, he said.

" This is a very important study, " commented Arthur McCullough, M.D., of the

Cleveland Clinic, who is president of the liver association.

He said hepatologists have been concerned that the use of a range of medications

-- including steroids, immunosuppressants, and cytokines -- in women with liver

transplants could affect their chances of a healthy baby although there has been

little hard evidence of risk.

" These are drugs that we just worry about, " he said.

" Patients would come to us and say, 'I really want to get pregnant,' " but until

now clinicians could offer little guidance, he said.

The study had support from Novartis Pharmaceuticals, Astellas Pharma, Roche

Laboratories, and Wyeth Pharmaceuticals. Dr. said he had no conflicts.

Primary source: Hepatology

Source reference:

C, et al " Structural Birth Defects in the Newborn of Female Liver

Transplant Recipients " Hepatology 2008; 48(4): Abstract 544.