title: Breast-feeding after transplantation.
abstract: Transplantation affords recipients the potential for a full life and, for some, parenthood. Female transplant recipients must continue to take immunosuppression during pregnancy and breast-feeding. This article reviews case and series reports regarding breast-feeding in those taking transplant medications. Avoidance of breast-feeding has been the customary advice because of the potential adverse effects of immunosuppressive exposure on the infant. Subsequent studies have demonstrated that not all medication exposure translates to risk for the infant, that the exposure in utero is greater than via breast milk and that no lingering effects due to breast-feeding have been found to date in infants who were breast-fed while their mothers were taking prednisone, azathioprine, cyclosporine, and/or tacrolimus. Thus, except for those medications where clinical information is inadequate (mycophenolic acid products, sirolimus, everolimus, and belatacept), the recommendation for transplant recipients regarding breast-feeding has evolved into one that is cautiously optimistic.
authors.affiliation: Temple University School of Medicine, Kresge West, 3440 N. Broad St., Suite 100, Philadelphia, PA 19140, USA. Electronic address: Serban.Constantinescu@tuhs.temple.edu.
authors.forename: Serban
authors.initials: S
authors.lastname: Constantinescu
authors.affiliation: Temple University School of Medicine, Kresge West, 3440 N. Broad St., Suite 100, Philadelphia, PA 19140, USA. Electronic address: Akshta.Pai@tuhs.temple.edu.
authors.forename: Akshta
authors.initials: A
authors.lastname: Pai
authors.affiliation: National Transplantation Pregnancy Registry (NTPR), Gift of Life Institute, 401 N. 3rd Street, Philadelphia, PA 19123, USA. Electronic address: lcoscia@giftoflifeinstitute.org.
authors.forename: Lisa A
authors.initials: LA
authors.lastname: Coscia
authors.affiliation: Institute of Cellular Medicine, 3rd Floor, Leech Building, Faculty of Medical Sciences, Framlington Place, Newcastle upon Tyne NE2 4HH, UK. Electronic address: J.M.Davison@newcastle.ac.uk.
authors.forename: John M
authors.initials: JM
authors.lastname: Davison
authors.affiliation: Lehigh Valley Hospital, 1250 S. Cedar Crest Blvd. Suite 210, Allentown, PA 18103, USA; University of South Florida, Morsani College of Medicine, Tampa, FL, USA. Electronic address: Michael.Moritz@lvhn.org.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Moritz
authors.affiliation: National Transplantation Pregnancy Registry (NTPR), Gift of Life Institute, 401 N. 3rd Street, Philadelphia, PA 19123, USA; University of Central Florida, Orlando, FL, USA. Electronic address: varmenti@giftoflifeinstitute.org.
authors.forename: Vincent T
authors.initials: VT
authors.lastname: Armenti
mesh_terms: D001942:Breast Feeding; D019317:Evidence-Based Medicine; D005260:Female; D017408:Guidelines as Topic; D006801:Humans; D007165:Immunosuppression Therapy / Q000009:adverse effects / Q000379:methods; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000032:analysis / Q000493:pharmacokinetics; D007223:Infant; D007231:Infant, Newborn; D008895:Milk, Human / Q000737:chemistry / Q000276:immunology; D016377:Organ Transplantation; D011247:Pregnancy; D012307:Risk Factors
chemical_list: D007166:Immunosuppressive Agents
keywords: breast milk; breast-feeding; immunosuppression; lactation; transplant