Pregnancy following lung transplant
Successful pregnancies have been reported in women with cystic fibrosis (CF) following lung transplants but it remains a high risk undertaking (Gyi et al, 2006).
Cyclosporin is not teratogenic in animals but there are only limited data in humans. Azathioprine is teratogenic in animals but has not been shown to cause an increased incidence of congenital abnormalities in humans. For both drugs there are insufficient data to conclude that they are safe or unsafe to use during pregnancy but the suggestion from the reports available is that neither drug is teratogenic. The safety of the new immunosuppressant drugs is, however, not established with concerns raised that the risk of birth defects and/or spontaneous miscarriage might be increased in women taking mycophenolate mofetil (Knoop, 2002).
There is thought to be an increased risk of rejection of the transplanted lungs with pregnancy in the first two to three years after surgery and pregnancy should be avoided during this time (Budev et al, 2005). The risks of acute rejection, hypertension and diabetes after pregnancy in lung transplant recipients appears greater than that for other solid organ transplants (Budev et al, 2005).
We believe that all women with CF who have received successful transplants and who wish to become pregnant should discuss this with their transplant centre physicians and follow advice given.
Budev MM, Arroliga A, Emery S. Exacerbation of underlying pulmonary disease in pregnancy. Crit Care Med 2005; 33: S313-S318. [PubMed]
Gyi KM, Hodson ME, Yacoub MY. Pregnancy in cystic fibrosis lung transplant recipients: case series and review. J Cyst Fibros 2006; 5: 171-175. [PubMed]
Knoop C. Pregnancy in cystic fibrosis. J Cyst Fibros 2002; 1: 294-295. [PubMed]