DRUG SAFETY ISSUES IN PREGNANCY FOLLOWING TRANSPLANTATION AND IMMUNOSUPPRESSION - EFFECTS AND OUTCOMES

Successful pregnancy outcomes are possible after solid organ transplan tation. While there are risks to mother and fetus, there has not been an increased incidence of malformations noted in the newborn of the tr ansplant recipient. It is essential that there is closely coordinated care that involves the transplant team and an obstetrician in order to obtain a favourable outcome. Current data from the literature, as wel l as from reports from the National Transplantation Pregnancy Registry (NTPR), support the concept that immunosuppression be maintained at a ppropriate levels during pregnancy; At present, most immunosuppressive maintenance regimens include combination therapy, usually cyclosporin or tacrolimus based. Most female transplant recipients will be receiv ing maintenance therapy prior to and during pregnancy. For some agents , including monoclonal antibodies and mycophenolate mofetil, there is either no animal reproductive information or there are concerns about reproductive safety. The optimal (lowest risk) transplant recipient ca n be defined by pre-conception criteria which include good transplant graft function, no evidence of rejection, minimum 1 to 2 years post-tr ansplant and no or well controlled hypertension. For these women pregn ancy generally proceeds without significant adverse effects on mother and child. It is of note that the epidemiological data available to da te on azathioprine-based regimens are favourable in the setting of a c ategory D agent (i.e. one that can cause fetal harm). Thus, there is s till much to learn regarding potential toxicities of immunosuppressive agents. The effect of improved immunosuppressive regimens which use n ewer or more potent (and potentially more toxic) agents will require f urther study.