Low Content of Cyclosporine A and Its Metabolites in the Colostrum of Post-Transplant Mothers

• Main Authors: Bożena Kociszewska-Najman, Natalia Mazanowska, Beata Borek-Dzięcioł, Leszek Pączek, Emilia Samborowska, Monika Szpotańska-Sikorska, Bronisława Pietrzak, Michał Dadlez, Mirosław Wielgoś
• Format: Article
• Language: English
• Published: MDPI AG 2020-09-01
• Series: Nutrients
• Subjects: breastfeeding; immunosuppression; cyclosporine A; transplant; lactation
• Online Access: https://www.mdpi.com/2072-6643/12/9/2713

The rate of post-transplant mothers who breastfeed while on immunosuppression is progressively increasing. Data on breastfeeding while on cyclosporine-based regimens are limited. Therefore, we assessed the amount of cyclosporine and its metabolites that might be ingested by a breastfed infant by measuring the concentration of cyclosporine and its metabolites in the colostrum of seven post-transplant mothers. The mean concentration of cyclosporine in the colostrum was 22.40 ± 9.43 mcg/L, and the estimated mean daily dose of the drug was 1049.22 ± 397.41 ng/kg/24 h. Only three metabolites (AM1, DHCsA, and THCsA) had mean colostrum amounts comparable to or higher than cyclosporine itself, with the daily doses being 468.51 ± 80.37, 2757.79 ± 1926.11, and 1044.76 ± 948.56 ng/kg/24 h, respectively. Our results indicate a low transfer of cyclosporine and its metabolites into the colostrum in the first two days postpartum and confirm the emerging change to the policy on breastfeeding among post-transplant mothers. A full assessment of the safety of immunosuppressant exposure via breastmilk will require further studies with long-term follow-ups of breastfed children.