Development of Children Born to Female Liver or Kidney Recipients

Background: Neonates born to transplant recipients have higher rate of prematurity and low-birth-weight. Chronic immunosuppression during pregnancy may have adverse effect on developing fetus and impair later development of the neonate, infant and child.

Objective: The aim of this study was to assess the neurological and somatic development of children born to mothers after liver (LT) or kidney (KT) transplantation exposed to chronic immunosuppression in utero.

Methods: Study group involved 82 children, including 46 children in LT and 36 children in KT group. Control group consisted of 82 children born to healthy mothers. Neurologic abnormalities were divided into light, moderate and severe. In the somatic assessment body weight, body mass index (BMI), length/height and head circumference of children were included. Anthropometric measurements and BMI were compared to the percentile values matched to the sex and age.

Results: Neurological examination was normal in 40 (86.9%) LT children and in 31 (86.1%) KT children. Light disorders were found in 5 (10.9%) LT children and in 4 (11.1%) KT children. Moderate disorders were present in 1 (2.2%) LT child and in 1 (2.8%) KT child. There were no severe disorders (cerebral palsy). Percentage of abnormalities in neurological examination was similar in study and control groups (p=0.32). In the somatic assessment higher prevalence of obesity was found in study group (16.4%) compared to controls (6.3%), p=0.037. Obesity was observed in both groups, more frequently (LT 17.1% and KT 15.4%) than in general population (5%) (p<0.05). This difference was not observed in control groups. Tacrolimus prenatal exposure seems to associate with increased risk of obesity in children.

Conclusions: Chronic immunosuppressive treatment does not affect negatively neurologic development of the children born to graft recipients. Somatic differences, in particular obesity in children born to posttransplant mothers, may be associated with immunosuppressive treatment used in pregnancy.