PATERNITY BY CARDIAC TRANSPLANT RECIPIENTS

To assess whether children fathered by cardiac transplant recipients a re at high risk of teratogenicity, cardiac transplant centers listed w ith the International Society for Heart and Lung Transplantation were surveyed. Paternities after transplantation by heart (n=35) and heart- lung (n=1) allograft recipients have resulted in 42 pregnancies (child ren's age 3.3+/-0.3 years). The fathers' age at conception was < 45 ye ars in 40 (95%) and > 45 years in 2 (5%). Most fathers (86%) were enjo ying an active and healthy lifestyle at the time of conception; one (2 %) was on dialysis and listed for kidney transplantation due to nephro tic syndrome, 1 (2%) had asthma, 4 (10%) had allograft coronary diseas e (1 died while waiting for second heart transplant when the child was 2 months old), and 2 (5%) were retransplanted after the pregnancies. Immunosuppressive regimens were reported for 37 paternities; drug prot ocols at the time of conception were as follows: 25 (60%) CsA/predniso ne/AZA, 6 (14%) CsA/prednisone, 4 (10%) CsA/AZA, and 2 (5%) AZA/predni sone. Twenty-six (62%) had received treatment for rejection episodes b efore conception; seven (17%) had received treatment for rejections si nce conception. Of the 42 children fathered by these recipients, 3 (7% ) were preterm, 1 (2%) had a cleft palate and lip that have subsequent ly been corrected, 1 (2%) died from interruption of umbilical cord cir culation at 24 weeks, and 1 (2%) whose father had familial cardiomyopa thy was born with a cardiomyopathy that improved with time. Although t he numbers are small, the available data suggest that paternity by car diac transplant recipients may be safe.