Timing of Pregnancy After Kidney Transplantation and Risk of Allograft Failure

Rose, Caren; Gill, Jagbir; Zalunardo, Nadia; Johnston, Olwyn; Mehrotra, Anita; Gill, John S.

doi:10.1111/ajt.13773

Cited by 77 publications

(49 citation statements)

References 26 publications

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“…28 A recent analysis of US Medicare data described elevated rates of graft loss with conception up to 24 months after KT. 29 Pre-existing hypertension and severity of graft dysfunction prior to conception have been shown to be independently associated with graft failure in KT recipients. [30][31][32] it is uncertain whether there is disproportionate reduction in bound versus free tacrolimus levels.…”

Section: Maternal/graft Risksmentioning

confidence: 99%

Reproductive health in women following abdominal organ transplant

Sarkar

Bramham

Moritz

et al. 2018

American Journal of Transplantation

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Fertility is commonly impaired in women with end-stage kidney and liver disease, although most women will have restoration of fertility within 1 year of transplant. Family planning is therefore critical to discuss with reproductive-aged transplant recipients in the early posttransplant period, in order to ensure timely initiation of contraception, and optimal timing for conception. For women seeking pregnancy, the risks to the mother, graft, and baby should be discussed, including evaluation of immunosuppression safety and potential for adjusting medications prior to conception. With an increasing number of transplant patients now breastfeeding, immunosuppression safety in lactation continues to carry great importance.

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Section: Maternal/graft Risksmentioning

confidence: 99%

Reproductive health in women following abdominal organ transplant

Sarkar

Bramham

Moritz

et al. 2018

American Journal of Transplantation

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“…Waiting longer may also result in impaired renal function postpartum which may fail to recover with already declining renal function due to chronic allograft nephropathy. However, a recent study reported that there is an increased risk of allograft failure to pregnancies in both first posttransplant year (HR: 1.25; 95% CI: 1.04, 1.50) and second posttransplant year (HR: 1.26; 95% CI: 1.06, 1.50), while pregnancy in the third posttransplant year was not associated with an increased risk of death censored graft loss [30]. …”

Section: Optimal Time To Conceptionmentioning

confidence: 99%

Overview of Pregnancy in Renal Transplant Patients

Shah

Verma

2016

International Journal of Nephrology

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Kidney transplantation offers best hope to women with end-stage renal disease who wish to become pregnant. Pregnancy in a kidney transplant recipient continues to remain challenging due to side effects of immunosuppressive medication, risk of deterioration of allograft function, risk of adverse maternal complications of preeclampsia and hypertension, and risk of adverse fetal outcomes of premature birth, low birth weight, and small for gestational age infants. The factors associated with poor pregnancy outcomes include presence of hypertension, serum creatinine greater than 1.4 mg/dL, and proteinuria. The recommended maintenance immunosuppression in pregnant women is calcineurin inhibitors (tacrolimus/cyclosporine), azathioprine, and low dose prednisone; and it is considered safe. Sirolimus and mycophenolate mofetil should be stopped 6 weeks prior to conception. The optimal time to conception continues to remain an area of contention. It is important that counseling for childbearing should start as early as prior to getting a kidney transplant and should be done at every clinic visit after transplant. Breast-feeding is not contraindicated and should not be discouraged. This review will help the physicians in medical optimization and counseling of renal transplant recipients of childbearing age.

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“…It has therefore been a focus on pregnancy safety and outcome for immunosuppressed women. 3-5 Mycophenolic acid (MPA) is the active immunosuppressive substance in both mycophenolate mofetil (MMF) and mycophenolate sodium (MPS), and it reduces the incidence of acute rejection and benefits graft survival. 6 From previous studies, it is well known that exposure to MPA in early pregnancy of female transplant recipients has been associated with increased rate of miscarriages and birth defects in the live born.…”

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confidence: 99%

Exposure to Mycophenolate and Fatherhood

et al. 2017

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BackgroundMycophenolic acid (MPA) is the active immunosuppressive substance in both mycophenolate mofetil and mycophenolate sodium, and it is widely used after organ transplantation. In women, taking MPA is teratogenic and may also influence spermatogenesis. There is a lack of knowledge regarding outcome of pregnancies fathered by men exposed to MPA.MethodsWe compared outcomes in pregnancies fathered by renal transplant men per whether they had been exposed to MPA or not at time of conception. A nationwide population-based retrospective cohort study was performed. Data from the Norwegian Renal Registry with all renal transplanted men alive between January 1, 1995 and December 31, 2015 were included, and relevant outcome data were extracted from the Medical Birth Registry of Norway.ResultsDuring the given time, 230 immunosuppressed renal transplanted men fathered 350 children (155 on MPA/195 not on MPA). There were no significant increased risks of malformation (3.9% vs. 2.6%, P = 0.49) in MPA exposed versus unexposed cohorts of children. The average dose (±SD) of mycophenolate was 1.42 ± 0.3 g/day and the individual median MPA trough concentration in the time period of anticipated conception and pregnancy was 2.8 ± 1.6 mg/L. Birth weight was similar in exposed and unexposed cohorts of children; 3381 ± 681 g vs. 3429 ± 714 g (P = 0.53).ConclusionsPaternal exposure to MPA did not increase the risk of adverse birth outcomes in children fathered by male kidney transplanted patients. These results are reassuring and support the continuation of paternal MPA treatment before, during, and after conception.

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Timing of Pregnancy After Kidney Transplantation and Risk of Allograft Failure

Cited by 77 publications

References 26 publications

Reproductive health in women following abdominal organ transplant

Reproductive health in women following abdominal organ transplant

Overview of Pregnancy in Renal Transplant Patients

Exposure to Mycophenolate and Fatherhood

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