Congenital Infections in Neonates of Women With Liver or Kidney Transplants.

BACKGROUND: Immunosuppressive therapy is associated with an increased risk of pregnancy complications and may have adverse effects for the newborn. The aim of this study was to determine the frequency and the type of early congenital infections and to assess typical markers of infections in neonates of liver and kidney recipients. METHODS: A retrospective analysis of 71 neonates born to either liver (39 cases) or kidney transplanted women (32 cases) was conducted. The rate and the type of newborns' infections as well as laboratory and bacteriologic markers of infections were analyzed. RESULTS: There was no significant difference in the frequency of congenital infections between the LT and KT groups (8 vs 7 cases; P = .879).). The rate of infections was not significantly higher in both groups compared with the general population. Infections were detected in 23.9%, 13.6%, and 26.6% of neonates born to mothers using tacrolimus, cyclosporine, and azathioprine respectively. No significant differences in white blood count or levels of neutrocytes and lymphocytes were observed between the groups. No abnormalities in white blood smear, but 1 case of leukopenia in the kidney transplant group, were detected. CONCLUSIONS: The rate of congenital infections in neonates of allograft recipients is not significantly higher than in the general population. Immunosuppressive regimens with azathioprine seem to carry the greatest risk, it is a little lower in the tacrolimus group, and cyclosporine-based regimens have the lowest risk of congenital infections. Differences were not statistically significant. Prenatal exposure to immunosuppressive agents seems not to be associated with any hematologic disturbances in white blood count and white blood smear.

Evaluation of selected markers of the immune system in children of renal transplant recipients.

OBJECTIVE: The aim of this study was to evaluate whether chronic use of immunosuppressive drugs during pregnancy in women after renal transplantation affects the concentration of immunoglobulin G (IgG) and IgM in the serum of their children. MATERIAL: Seventy-eight children aged 1 day to 15 years were enrolled. The study group consisted of 39 children born to renal transplant recipient mothers. The control group comprised 39 children whose mothers had not received immunosuppressive medications during pregnancy and were born at similar gestational age. METHODS: Serum concentrations of IgG and IgM were evaluated with the use of agglutination immunoassays on Siemens or Cobas device. Age-adjusted reference values for immunoglobulins formulated by Wolska-Kusnierz et al were used. Statistical analysis was performed with the use of Statistica 10.0 software with P value <.05 considered significant. RESULTS: Normal IgG concentrations were found in 82.05% (32) of children from the study group and 79.49% (31) of the control group. IgG concentrations below normal range were observed in 12.82% (5) of children from the study group and in 15.38% (6) of the control group. Normal concentrations of IgM were found in 53.85% (21) of children from the study group and in 61.54% (24) of the control group. Decreased levels of IgM were observed in 38.46% (15) of children from the study group and 35.9% (14) of the control group. There were no significant differences regarding the analyzed values between the groups. CONCLUSION: The exposure to chronic intrauterine immunosuppression had no significant effect on the concentration of IgG or IgM in children born to kidney transplant recipients.

Analysis of the selected biochemical parameters of liver and kidney function in children of mothers after liver transplantation.

INTRODUCTION: Children of mothers after liver transplantation (LT) are exposed during fetal life to the immunosuppressive agents. These drugs may have hepatotoxic and nephrotoxic effects. OBJECTIVES: The aim of the work was to assess liver and kidney parameters of children born from mothers who had LT. MATERIALS AND METHODS: The research included 51 children of mothers after LT and 51 children from a control group who were born in the First Department of Obstetrics and Gynecology in Warsaw between 2001 and 2013. The control group consisted of children born in the similar gestational age. Analysis concerned neonates, infants, and children older than 12 months. Two liver parameters (alanine transaminase [ALT] and aspartate transaminase [AST]) as well as two kidney parameters (urea and creatinine) were assessed. For statistical analysis we used Fisher's exact test and the Mann-Whitney test. RESULTS: All children from the LT group had correct ALT levels. In the control group, 5 of 51 cases (9.8 %) had levels that were greater than the norm, and those cases concerned only children younger than 12 months. The average concentration of ALT in the LT group was 15.14 U/L and the average for the control group was 22.6 U/L (P = .012699, Mann-Whitney test). Three of 51 children in the LT group (5.9%) and 8 of 51 (15.7%) in the control group had AST levels that were increased (P = .2003; Fisher's exact test). Incorrect AST levels were reported in all age groups. Incorrect values of kidney parameters concerned only neonates. Increased creatinine levels were reported in 3 of 51 cases (5.9%) in the LT group and in 1 of 51 cases (1.96%) in the control group (P = .6175; Fisher's exact test). The average concentration of creatinine in children of mothers after LT was 0.51 mg/dL, and the average of the control group was 0.44 mg/dL (P = .223698; Mann-Whitney test). Only 1 of 51 children in the LT group (1.96%) had an increased urea level. All children from both the LT and the control groups had normal ultrasound images of urinary tract and liver. CONCLUSION: Exposure to immunosuppressive drugs during fetal life does not result in the occurrence of serious disturbances of liver function and kidneys function in children of mothers after LT.

Neurological development of children born to liver transplant recipients.

INTRODUCTION: Immunosuppressive treatment used in pregnant liver recipients may have a negative impact on fetal development and successively a child. AIM: The aim of the study was to make a neurological assessment of infants and children born to liver transplant recipients (LTRs) born between December 4, 2001, and February 11, 2013, in the 1(st) Department of Obstetrics and Gynecology, Medical University of Warsaw. METHODS AND MATERIALS: The study involved 88 children, of whom 44 children were born to LTR mothers, and 44 children born to women who were not organ recipients and delivered at a similar gestational age. The gestational age of neonates ranged from 33 to 41 weeks, and the birth weight ranged from 1420 g to 4100 g. The neurological examination was performed in children from 7 weeks to 10 years of age. The neurological development was assessed by a specialist in pediatric neurology. The results of the examination were divided according to the following criteria: 1) normal development, 2) slight disorders, 3) moderate disorders, and 4) severe disorders. The Fisher's exact test was used for statistical analysis. RESULTS: Normal development was found in 35 of 44 (79.54%) children in the LTR group and 39 of 44 (88.63%) children in the control group (P = .3827). Slight disorders were observed in 6 of 44 (13.63%) children in LTR group and 5 of 44 (11.36%) children in the control group. Moderate disorders were found only in 3 of 44 (6.81%) children in the LTR group. No severe disorders were observed in both groups. CONCLUSIONS: Neurological development of children born to the liver recipients who were exposed to chronic immunosuppressive treatment in their fetal lives is the same as that of children whose mothers have not undergone organ transplantation.