Department of Pharmacy, University of North Carolina Medical Center, Chapel Hill, NC, USA.
Department of Pharmacy, University of Maryland Medical Center, Baltimore, MD, USA.
Paediatr Drugs. 2022 Sep;24(5):483-497. doi: 10.1007/s40272-022-00525-y. Epub 2022 Jul 23.
Solid organ transplantation (SOT) is a lifesaving procedure for those with end-stage kidney, liver, heart, lung, and intestinal diseases, including females of childbearing age who wish to proceed with pregnancy following transplantation. While there is clear risk associated with use of mycophenolate during pregnancy, the risks associated with use of other immunosuppressant agents are less well understood, and the timing of use in pregnancy may be pertinent when considering the risk versus benefit for individual patients. In addition to overall fetal outcomes, including gestational age, birth weight, and mortality, this review summarizes published literature on additional complications that have been examined in association with maternal use during pregnancy and postpartum while breastfeeding. Compared with non-transplant pregnancies, pregnancies in transplant recipients are associated with lower birth weight and earlier gestational age. Effects associated with particular immunosuppressant agents in the infant include renal dysfunction from calcineurin inhibitors, myelosuppression from azathioprine, and decreased circulating immune cells with several agents. However, these effects are noted to primarily be transient, though the decrease in immune cells may predispose the infant to increased infectious complications in the first year of life. Utilizing relative infant dose estimations, nearly all commonly utilized immunosuppressants are likely safe during breastfeeding given the limited exposure to the infant.
实体器官移植（SOT）是挽救那些患有终末期肾脏、肝脏、心脏、肺和肠道疾病的患者的生命的方法，包括希望在移植后继续怀孕的育龄女性。虽然在怀孕期间使用吗替麦考酚酯有明确的风险，但使用其他免疫抑制剂的风险则不太清楚，并且在考虑个体患者的风险与收益时，在怀孕期间使用的时间可能很重要。除了包括胎龄、出生体重和死亡率在内的整体胎儿结局外，本文综述还总结了与母亲在怀孕期间和哺乳期使用相关的已发表文献中检查到的其他并发症。与非移植妊娠相比，移植受者的妊娠与较低的出生体重和较早的胎龄相关。与特定免疫抑制剂在婴儿中的作用相关的包括来自钙调磷酸酶抑制剂的肾功能障碍、来自硫唑嘌呤的骨髓抑制以及几种药物引起的循环免疫细胞减少。然而，这些作用主要是短暂的，尽管免疫细胞的减少可能使婴儿在生命的第一年更容易发生感染并发症。利用相对婴儿剂量估计，鉴于婴儿接触有限，几乎所有常用的免疫抑制剂在母乳喂养期间可能都是安全的。
