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Abstract: PO2541

Calcineurin Inhibitor-Based Immunosuppression Has Negligible Negative Effects on Pregnancy Outcomes After Renal Transplantation in the Netherlands

Session Information

Category: Transplantation

  • 1902 Transplantation: Clinical

Authors

  • Koenjer, Lisanne M., Radboudumc, Nijmegen, Gelderland, Netherlands
  • Meinderts, Jildau R., Universitair Medisch Centrum Groningen, Groningen, Groningen, Netherlands
  • van der Heijden, Olivier Willem Hendrik, Radboudumc, Nijmegen, Gelderland, Netherlands
  • Lely, Titia, Universitair Medisch Centrum Utrecht, Utrecht, Utrecht, Netherlands
  • de Jong, Margriet, Universitair Medisch Centrum Groningen, Groningen, Groningen, Netherlands
  • van der Molen, Renate G., Radboudumc, Nijmegen, Gelderland, Netherlands
  • Van Hamersvelt, Henk W., Radboudumc, Nijmegen, Gelderland, Netherlands

Group or Team Name

  • Pregnancy After Renal Transplant OUTcomes (PARTOUT) Network
Background

Pregnancy among renal transplant recipients (RTR) has increased over the past years, also in patients with compromised renal function and/or proteinuria. Immunosuppressive regimens may influence pregnancy outcomes and it is not yet clear whether replacing a calcineurin inhibitor (CNI) by a CNI-free (CNI-) regimen has a favourable effect.

Methods

We therefore retrospectively compared the effect of CNI-based (CNI+) and CNI- immunosuppression in the first trimester of pregnancy on maternal and fetal outcomes in Dutch pregnancies between 1986-2017 in RTR.

Results

We identified 129 CNI+ and 125 CNI- singleton pregnancies. Demographics did not differ except for higher BMI in CNI+ (median 25.3 vs 23.7 kg/m2, p=0.01), year of renal transplantation (2000 in CNI+ vs 1989 in CNI-, p<0.01), year of pregnancy (2006 in CNI+ vs 1998 in CNI-; p<0.01) and interval of transplantation to pregnancy (69 in CNI+ vs 104 months in CNI-; p<0.01). In the third trimester creatinine levels were significantly higher in CNI+ (127 vs 105 µmol/L in CNI-, P<0.01) but this difference had disappeared 6-18 months postpartum. The percentual change in creatinine from preconceptional to the third trimester level was slightly different (+3.1% in CNI+ vs 2.2% in CNI-, P=0.05). In both groups, a postpartum 11-12% creatinine increase from preconceptional level was observed (p=0.92). Regarding fetal outcomes, a trend in increased incidence of birthweight <2500 grams was seen in CNI+ (52% vs 40%, p=0.07) and in both groups there was a high rate of preterm delivery <37 weeks (49% vs 45% in CNI-; p=0.55).

Conclusion

Our data indicate that CNI do not negatively influence the course of renal function up to 18 months postpartum, but only lead to a more pronounced increase in serum creatinine levels towards the end of pregnancy. However, the substantial short term loss of renal function and the high rates of premature birth rate and low birthweight classify them as high-risk pregnancies that should be followed carefully in tertiairy obstetric/nephrologic care programs. Our data do not exclude possible long term negative effects of CNI on overall health, renal function or hypertension in the offspring of these women.