Table 1 Immunosuppressants and their side effects in pregnant liver transplant recipients

Corticosteroids

IL-2 synthesis inhibition

Hypertension Gestational diabetes Osteonecrosis Cataracts Striae

Malformation (4%, esp. cleft palate) Low birth weight PROM Adrenal suppression Infection

[6, 12]

Cyclosporine

Inhibition of cytokine production

Hypertension Gestational diabetes Renal dysfunction Uterine dystonia Seizures

Malformation (3–5%; no consistent pattern known) Low birth weight Jaundice Cytopenia Hypoglycemia Intracerebral hemorrhage

[6, 13, 14]

Azathioprine

Antimetabolic: inhibition of the biosynthesis of purine nucleotides

Leukopenia Gastrointestinal side effects

Malformation (7%; esp. aphallia, hypo- or dysplasia of lungs and urinary bladder) IUGR Premature delivery Adrenal hypoplasia Infection

[6, 13, 15, 16]

Tacrolimus

Inhibition of T-lymphocytes activation by inhibition of calcineurin

Hypertension Gestational diabetes Renal dysfunction Neurotoxicity Diarrhea Alopecia Pruritus

Malformation (6%; no consistent pattern known) Transient increase of potassium Impaired renal function

[6, 17–19]

Mycophenolate mofetil

Inhibition of de novo synthesis of purines

Leukopenia Gastrointestinal side effects

Malformation (22%; esp. cleft lip and palate, micrognathia, ear malformations) 1st trimester fetal loss Anemia

[6, 20, 21]