Abstract: FR-PO1011
Gestational Diabetes, Hypertension, and Preeclampsia in Kidney or Liver Transplant Recipients
Session Information
- Transplantation: Clinical - Pharmacology and Nonkidney Solid Organ Transplants
November 07, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 2102 Transplantation: Clinical
Authors
- Constantinescu, Serban, Temple University, Philadelphia, Pennsylvania, United States
- Robinson, Noah Jamie, Astellas Pharma AG, Wallisellen, ZH, Switzerland
- Zhu, Fengzheng, Temple University, Philadelphia, Pennsylvania, United States
- Blogg, Martin, Astellas Pharma Europe Ltd, Chertsey, England, United Kingdom
- Coscia, Lisa, Gift of Life Institute, Philadelphia, Pennsylvania, United States
- Kliniewski, Dorothy, Gift of Life Institute, Philadelphia, Pennsylvania, United States
- Moritz, Michael J., Gift of Life Institute, Philadelphia, Pennsylvania, United States
Background
Tacrolimus-containing regimens (Tac) are the most common immunosuppressant regimens post-transplant. This study estimated the prevalence of and risk factors for gestational diabetes (GDM), gestational hypertension (GH) and preeclampsia among pregnant kidney or liver transplant recipients using Tac or non-tacrolimus-containing regimens (non-Tac), i.e. either cyclosporine-containing regimens (CsA), or only prednisone and/or azathioprine (P/A).
Methods
Transplant Pregnancy Registry International from its initiation (1991) to 31 Dec. 2020 was used to study 3 groups using different immunosuppressant regimens during pregnancy. Multivariate logistic regression was conducted to assess risk factors for maternal outcomes of pregnancies exposed to Tac or non-Tac.
Results
The prevalence of GDM was around 7% with no evidence of a systematic difference between Tac and non-Tac in the regression analysis. Each unit increase in BMI prior to pregnancy was associated with a 7% increased risk of GDM in liver recipients (aOR 1.07, 95% confidence interval (CI): 1.01-1.14). For Tac and CsA, the prevalence of GH was higher among kidney than liver recipients, with non-overlapping CIs (see table). There was no difference for risk of GH between Tac and non-Tac in the regression analysis. Tac was associated with a higher risk of preeclampsia than non-Tac in the kidney group (aOR 1.77, 95% CI: 1.39-2.26), but not in the liver group (aOR 0.89, 95% CI: 0.53-1.49). Each unit increase in BMI prior to pregnancy was associated with a 4% increased risk of preeclampsia in liver recipients (aOR 1.04, 95% CI: 1.00-1.09).
Conclusion
In kidney or liver recipients, there was no evidence of higher risk of GDM or GH in Tac than non-Tac. In kidney recipients only, Tac was associated with an increased risk of preeclampsia. Higher BMI was associated with GDM and preeclampsia in liver recipients.
| Transplanted organ | Kidney | Liver | ||||
| Treatment group | Tac | CsA | P/A | Tac | CsA | P/A |
| Pregnancies, n | 841 | 902 | 444 | 458 | 214 | 20 |
| % GDM (n/N), 95% CI* | 7.8 (57/730) 6.0-10.0 | 7.3 (59/807) 5.6-9.3 | 9.8 (38/389) 7.0-13.2 | 4.5 (18/398) 2.7-7.1 | 1.4 (3/209) 0.3-4.1 | 0 (0/20) 0.0-16.8 |
| % GH (n/N), 95% CI** | 15.4 (65/422) 12.1-19.2 | 18.7 (75/401) 15.0-22.9 | 4.8 (15/311) 2.7-7.8 | 4.6 (17/372) 2.7-7.2 | 7.8 (11/141) 4.0-13.5 | 0 (0/20) 0.0-16.8 |
| % Preeclampsia (n/N), 95% CI*** | 35.5 (221/623) 31.7-39.4 | 27.9 (193/692) 24.6-31.4 | 19.8 (75/379) 15.9-24.2 | 21.3 (71/334) 17.0-26.0 | 23.4 (40/171) 17.3-30.5 | 0 (0/13) 0.0-24.7 |
*GDM cohort, i.e. with no DM prior to pregnancy, n= 2553; **GH cohort, i.e. with no hypertension prior to pregnancy, n= 1667; ***Preeclampsia cohort, i.e. where gestation ≥20 weeks, n= 2212
Funding
- Commercial Support – Astellas Pharma Europe B.V.