Pregnancies fathered by transplant recipients
Lisa Coscia1, Serban Constantinescu1,2, Michael J. Moritz1,3,4.
1Transplant Pregnancy Registry International, Philadelphia, PA, United States; 2Medicine, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, United States; 3Surgery, Lehigh Valley Health Network, Allentown, PA, United States; 4Surgery, Morsani College of Medicine, Tampa, PA, United States
The purpose of this study was to analyze 1408 pregnancy outcomes fathered by 875 male solid organ transplant recipients including exposure to mycophenolic acid products (MPA) and sirolimus. Data were collected by the Transplant Pregnancy Registry International (TPRI) via telephone interviews, online questionnaires, and review of medical records. Overall pregnancy outcomes fathered by transplant recipients are similar to the general US population (Table).
| Organ(s) | Recipients | Pregnancies/Outcomes* | MPA exposure | Live births (%) | Mean gestational age (weeks) | Mean birthweight (g) | Birth Defects (%) |
| Kidney | 632 | 997 / 1019 | 21% | 92% | 39 ± 2.3 | 3357 ± 596 | 3.5% |
| Heart | 121 | 181 / 188 | 23% | 89% | 38.7 ± 2.4 | 3351 ± 659 | 3.6% |
| Liver | 87 | 148 / 155 | 22% | 87% | 39 ± 1.9 | 3318 ± 606 | 3.8% |
| Kidney-Pancreas | 35 | 44 / 46 | 40% | 91% | 38.7 ± 2.4 | 3321 ± 589 | 2.4% |
| General Population | 39 | 3389 | 4-6% | ||||
| *includes twins, triplets | |||||||
Of the total fathered pregnancy experience, there were 333 outcomes with exposure to MPA. Outcomes included 297 (89%) live births, 33 (9.9%) miscarriages, 2 stillbirths and 1 ectopic pregnancy. Among the live births there were 11 birth defects reported (3.7%) and included: undescended testicle (n=2), tongue tied, pyloric stenosis, club foot, ureteral reflux, ventricular septal defect, Klinefelter's syndrome, Prader-Willi syndrome, Down's syndrome, and diaphragmatic hernia (neonatal death).
Although male fertility has been reported to be decreased in males maintained on sirolimus, there are 29 fathered pregnancies resulting in 28 livebirths with 1 birth defect (ureteral stricture) and 1 miscarriage with exposure to sirolimus.
Conclusions: The outcomes of pregnancies fathered by male transplant recipients are comparable to the general population and there is no evidence that male recipients need to avoid MPA when considering fathering a pregnancy. Data regarding sirolimus remains limited, however, to date increased risks for pregnancies fathered while taking sirolimus have not appeared. All transplant centers should encourage their recipients to participate in the TPRI.
