Document Detail

Cholestasis in pregnancy associated with ciclosporin therapy in renal transplant recipients.
MedLine Citation:
PMID:  17081234     Owner:  NLM     Status:  MEDLINE    
Obstetric cholestasis (OC) presents with pruritus in the second half of pregnancy and is associated with increased risk of foetal distress, intra-uterine death and premature delivery. From a tertiary referral, renal-obstetric clinic, we report the occurrence of OC in 5/23 pregnancies of women with renal transplants maintained on ciclosporin treatment (European incidence 0.1-1.5% of pregnancies). All required premature delivery for foetal reasons at 33-37/40 (median 34/40). Ciclosporin, at therapeutic concentrations, inhibits bile salt excretion pump (BSEP) function in rats and humans. We propose that OC developed in our patients because the mild inhibition of the canalicular pumps by ciclosporin was only revealed in pregnancy when increases in progesterone metabolites overwhelmed pump function. We suggest that all pregnant women receiving ciclosporin should be closely monitored from the second trimester for the development of OC. If detected, enhanced foetal and maternal monitoring to optimize time of delivery and pregnancy outcome is required.
Clara Day; Peter Hewins; Lumaan Sheikh; Mark Kilby; Dawn McPake; Graham Lipkin
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Transplant international : official journal of the European Society for Organ Transplantation     Volume:  19     ISSN:  0934-0874     ISO Abbreviation:  Transpl. Int.     Publication Date:  2006 Dec 
Date Detail:
Created Date:  2006-11-03     Completed Date:  2006-12-22     Revised Date:  2009-02-26    
Medline Journal Info:
Nlm Unique ID:  8908516     Medline TA:  Transpl Int     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  1026-9     Citation Subset:  IM    
Queen Elizabeth Hospital, University Hospital Birmingham NHS Trust, Edgbaston, Birmingham, UK.
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MeSH Terms
ATP-Binding Cassette Transporters / antagonists & inhibitors
Bile Canaliculi / drug effects,  metabolism
Cholestasis / etiology*
Cyclosporine / adverse effects*
Immunosuppressive Agents / adverse effects*
Kidney Transplantation / adverse effects*
Pregnancy Complications / etiology*
Reg. No./Substance:
0/ABCB11 protein, human; 0/ATP-Binding Cassette Transporters; 0/Immunosuppressive Agents; 59865-13-3/Cyclosporine

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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