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. 2018 Feb 27;10(3):267.
doi: 10.3390/nu10030267.

Low Transfer of Tacrolimus and Its Metabolites into Colostrum of Graft Recipient Mothers

Bozena Kociszewska-Najman  1 , Natalia Mazanowska  2 , Bronislawa Pietrzak  3 , Leszek Paczek  4   5 , Monika Szpotanska-Sikorska  6 , Joanna Schreiber-Zamora  7 , Ewa Hryniewiecka  8 , Dorota Zochowska  9 , Emilia Samborowska  10 , Michal Dadlez  11   12 , Miroslaw Wielgos  13
Affiliations

Low Transfer of Tacrolimus and Its Metabolites into Colostrum of Graft Recipient Mothers

Bozena Kociszewska-Najman et al. Nutrients. .

Abstract

Currently, the majority of neonates born to organ recipient mothers on chronic immunosuppressive therapy are formula fed. However, over the past few years, evidence has grown, suggesting that breastfeeding might be possible and beneficial. We designed a study assessing the transfer of tacrolimus into the colostrum of posttransplant mothers. We assessed the amount of tacrolimus and its metabolites, M-1 and M-3, that would be ingested by the breastfed neonates. Concentrations of tacrolimus and its metabolites were measured in colostrum from 14 posttransplant mothers as well as in venous cord blood and venous blood of the neonates. Test material analysis was performed by liquid chromatography coupled with mass spectrometry (LC/MS). The amount of ingested formula was registered, which allowed for estimation of the amount of tacrolimus and its metabolites that would be ingested by breastfed infants. The mean amount of tacrolimus that would be ingested by the neonates in maternal milk was 151.4 ng/kg/24 h (standard deviation SD ± 74.39); metabolite M-1: 23.80 ng/kg/24 h (SD ± 14.53); and metabolite M-3: 13.25 ng/kg/24 h (SD ± 9.05). The peak level of tacrolimus and metabolite M-1 in colostrum was noted 8 h after an oral dose (3.219 ng/mL SD ± 2.22 and 0.56 ng/mL SD ± 0.60, respectively) and metabolite M-3 after 6 h (0.29 ng/mL SD ± 0.22). Low concentrations of tacrolimus and its metabolites, M-1 and M-3, in colostrum show that neonates will ingest trace amounts of the drug. Further studies are required to fully assess the safety of breastfeeding by posttransplant mothers.

Keywords: HPLC; breastfeeding; drug metabolism; drug safety; transplantation.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
The mean concentrations of tacrolimus (TAC) and its M-1 and M-3 metabolites in colostrum collected at consecutive timepoints (1t, 2t, 3t, 4t, 5t).
Figure 2
Figure 2
Distribution of tacrolimus and its metabolites M-1 and M-3 amount that would be ingested by breast-fed infants (ng/kg/24 h).
Figure 3
Figure 3
The mean concentration of tacrolimus (TAC) and its M-1 and M-3 metabolites in venous cord blood and in venous blood of the newborns.
See this image and copyright information in PMC

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