Last update Feb. 12, 2020

Maternal Transplant

Likely Compatibility

Fairly safe. Mild or unlikely adverse effects. Compatible under certain circumstances. Follow-up recommended. Read Commentary.

After an organ transplant, immunosuppressive medication should be taken for life to prevent the immune system (defense) from rejecting the transplanted organ as alien.
The patient has a higher risk of infections and greater likelihood of taking antibiotics.

Although not recommended a few years ago (EBPG 2002, Coady 2002), breastfeeding after transplantation is perfectly possible, without side effects for infants (Sarkar 2018, Coscia 2015, Thiagarajan 2013).

Most antibiotics are compatible with breastfeeding.
Most medications used to prevent transplant rejection are compatible with breastfeeding (Sarkar 2018, Constantinescu 2014, Singh 2011, Gardiner 2006, Munoz-Flores 2001, Nyberg 1998, Thiru 1997, Ziegenhagen 1988, Grekas 1984, Coulam 1982).


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Suggestions made at e-lactancia are done by APILAM team of health professionals, and are based on updated scientific publications. It is not intended to replace the relationship you have with your doctor but to compound it. The pharmaceutical industry contraindicates breastfeeding, mistakenly and without scientific reasons, in most of the drug data sheets.

Jose Maria Paricio, Founder & President of APILAM/e-Lactancia

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References

  1. Deans R, Gerstl B, Shand AW, Lyons S, Budden A, Barrett HL, Luxton G, Fernando M, Yong K, Keung K, Arulpragasam K, Pleass H, Wan KM, Kehag E, Pittman JE, Lotz M, Fenn M, Nesbitt-Hawes E, Byun L, Tang K, Brannstrom M, Abbott J. The first live term birth following uterus transplantation in Australia. Med J Aust. 2025 Oct 20;223(8):404-409. Abstract Full text (link to original source)
  2. Coscia LA, Kliniewski D, Rao S, et al. Breastfeeding after transplantation: 25 year review (1999-2024). Am J Transplant 2025;25:S772. Full text (link to original source)
  3. Kuczaj A, Danel A, Warwas S, Przybyłowski P, Śliwka J, Pawlak S, Trzcińska I, Hrapkowicz T. Toxic milk- should we still be afraid of breastfeeding while on tacrolimus therapy: A case study. J Heart Lung Transplant 2024;43:S631. Full text (link to original source)
  4. Boyle S, Sung-Him Mew T, Lust K, McKenzie S, Javorsky G, Parsonage W. Pregnancy Following Heart Transplantation: A Single Centre Case Series and Review of the Literature. Heart Lung Circ. 2021 Jan;30(1):144-153. Abstract
  5. Akamine Y, Fujiyama N, Kagaya H, Saito M, Miura H, Terada Y, Takahashi T, Satoh S, Miura M. Tacrolimus concentrations after renal transplantation in a mother-neonate dyad: Maternal, neonatal and breast milk measurements. J Clin Pharm Ther. 2021 Dec;46(6):1800-1803. Abstract
  6. Klintmalm GB, Gunby RT Jr. Successful Pregnancy in a Liver Transplant Recipient on Belatacept. Liver Transpl. 2020 Sep;26(9):1193-1194. Abstract
  7. Nure E, Pascale MM, Frongillo F, Franco A, Bianco G, Agnes S. Pregnancy After Liver Transplant: Neonatal Outcomes and Long-Term Maternal Follow-up. Transplant Proc. 2019 Nov;51(9):2948-2951. Abstract
  8. Sarkar M, Bramham K, Moritz MJ, Coscia L. Reproductive health in women following abdominal organ transplant. Am J Transplant. 2018 May;18(5):1068-1076. Abstract
  9. Kociszewska-Najman B, Mazanowska N, Pietrzak B, Paczek L, Szpotanska-Sikorska M, Schreiber-Zamora J, Hryniewiecka E, Zochowska D, Samborowska E, Dadlez M, Wielgos M. Low Transfer of Tacrolimus and Its Metabolites into Colostrum of Graft Recipient Mothers. Nutrients. 2018 Abstract Full text (link to original source) Full text (in our servers)
  10. Shah S, Verma P. Overview of Pregnancy in Renal Transplant Patients. Int J Nephrol. 2016;2016:4539342. Abstract
  11. Coscia LA, Constantinescu S, Armenti DP, Moritz MJ. The 25th Anniversary of the National Transplantation Pregnancy Registry. Clin Transpl. 2015;31:57-68. Abstract
  12. Durst JK, Rampersad RM. Pregnancy in Women With Solid-Organ Transplants: A Review. Obstet Gynecol Surv. 2015 Abstract
  13. Constantinescu S, Pai A, Coscia LA, Davison JM, Moritz MJ, Armenti VT. Breast-feeding after transplantation. Best Pract Res Clin Obstet Gynaecol. 2014 Nov;28(8):1163-73. Abstract
  14. López LF, Martínez CJ, Castañeda DA, Hernández AC, Pérez HC, Lozano E. Pregnancy and kidney transplantation, triple hazard? Current concepts and algorithm for approach of preconception and perinatal care of the patient with kidney transplantation. Transplant Proc. 2014 Abstract
  15. Lawrence RM. Circumstances when breastfeeding is contraindicated. Pediatr Clin North Am. 2013 Feb;60(1):295-318. Abstract
  16. Thiagarajan KM, Arakali SR, Mealey KJ, Cardonick EH, Gaughan WJ, Davison JM, Moritz MJ, Armenti VT. Safety considerations: breastfeeding after transplant. Prog Transplant. 2013 Jun;23(2):137-46. Abstract
  17. Gomez-Lobo V, Landy HJ, Matsumoto C, Fishbein TM. Pregnancy in an intestinal transplant recipient. Obstet Gynecol. 2012 Abstract
  18. Singh M, Qualie J, Currie A, Howarth ES, Khare MM. Is breastfeeding safe with azathioprine? Obstet Med. 2011 Sep;4(3):104-7. Abstract
  19. Grimer M; Caring for Australians with Renal Impairment (CARI). The CARI guidelines. Calcineurin inhibitors in renal transplantation: pregnancy, lactation and calcineurin inhibitors. Nephrology (Carlton). 2007 Abstract
  20. Gardiner SJ, Begg EJ. Breastfeeding during tacrolimus therapy. Obstet Gynecol. 2006 Feb;107(2 Pt 2):453-5. Abstract
  21. Coady NT. Maternal transplantation medications during breastfeeding. J Hum Lact. 2002 Abstract
  22. EBPG Expert Group on Renal Transplantation. European best practice guidelines for renal transplantation. Section IV: Long-term management of the transplant recipient. IV.10. Pregnancy in renal transplant recipients. Nephrol Dial Transplant. 2002 Abstract Full text (link to original source) Full text (in our servers)
  23. Muñoz-Flores-Thiagarajan KD, Easterling T, Davis C, Bond EF. Breast-feeding by a cyclosporine-treated mother. Obstet Gynecol. 2001 May;97(5 Pt 2):816-8. Abstract
  24. Nyberg G, Haljamäe U, Frisenette-Fich C, Wennergren M, Kjellmer I. Breast-feeding during treatment with cyclosporine. Transplantation. 1998 Abstract
  25. Thiru Y, Bateman DN, Coulthard MG. Successful breast feeding while mother was taking cyclosporin. BMJ. 1997 Abstract Full text (link to original source) Full text (in our servers)
  26. Jain A, Venkataramanan R, Fung JJ, Gartner JC, Lever J, Balan V, Warty V, Starzl TE. Pregnancy after liver transplantation under tacrolimus. Transplantation. 1997 Abstract Full text (link to original source) Full text (in our servers)
  27. Ziegenhagen DJ, Crombach G, Dieckmann M, Zehnter E, Wienand P, Baldamus CA. [Pregnancy during cyclosporin medication following a kidney transplant]. Dtsch Med Wochenschr. 1988 Abstract
  28. Grekas DM, Vasiliou SS, Lazarides AN. Immunosuppressive therapy and breast-feeding after renal transplantation. Nephron. 1984 Abstract Full text (link to original source) Full text (in our servers)
  29. Coulam CB, Moyer TP, Jiang NS, Zincke H. Breast-feeding after renal transplantation. Transplant Proc. 1982 Abstract

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