title: Effect of pregnancy on long-term kidney function in renal transplant recipients treated with cyclosporine and with azathioprine.
abstract: In order to investigate the effect of different immunosuppressive regimens and the time interval between transplantation and pregnancy on long-term outcome, we performed a case-control study in pregnant renal allograft recipients. Eighty-one pregnancies of kidney transplanted recipients were identified [cyclosporine (CYA): n = 40; azathioprine (AZA): n = 41]. Controls were matched with respect to important prognostic factors. Posttransplant follow-up was 91.3 +/- 5 months. Graft and patient survival were similar in both groups and there was no apparent effect of immunosuppression. A total of 28 recipients (33%) delivered within 2 years and 6 (8%) subjects within 1 year after transplantation, but these short transplantation-to-pregnancy intervals had no apparent adverse effect on long-term outcome. In contrast to AZA-treated patients, CYA-treated patients experienced an increase in serum creatinine postpartum (1.15 +/- 0.2 mg/dL vs. 1.61 +/- 0.1 mg/dL; p < 0.05). Whole blood CYA levels decreased transiently during pregnancy from 115.9 +/- 8 ng/mL to 80.7 +/- 7 ng/mL leading to a gradual increase in drug dose from 240 +/- 14 mg/day to 324 +/- 21 mg/day (p < 0.05). Following delivery, there was an increase in CYA concentrations to 173 +/- 5.4 ng/mL, requiring rapid dose tapering to baseline of 246 +/- 15 mg/day. Pregnancies in renal recipients do not affect long-term patient and graft survival, independent of the immunosuppression. No detrimental effect of short transplantation-to-pregnancy intervals on long-term graft function was detected.
authors.affiliation: Department of Gynecology and Obstetrics, Technical University of Munich, Germany. thorsten.fischer@lrz.tum.de
authors.forename: Thorsten
authors.initials: T
authors.lastname: Fischer
authors.forename: Hans-Hellmut
authors.initials: HH
authors.lastname: Neumayer
authors.forename: Ronald
authors.initials: R
authors.lastname: Fischer
authors.forename: Michael
authors.initials: M
authors.lastname: Barenbrock
authors.forename: Hans P
authors.initials: HP
authors.lastname: Schobel
authors.forename: Barbara C
authors.initials: BC
authors.lastname: Lattrell
authors.forename: Volker R
authors.initials: VR
authors.lastname: Jacobs
authors.forename: Stefan
authors.initials: S
authors.lastname: Paepke
authors.forename: Stephanie Pildner
authors.initials: SP
authors.lastname: von Steinburg
authors.forename: Barbara
authors.initials: B
authors.lastname: Schmalfeldt
authors.forename: Karl Theo M
authors.initials: KT
authors.lastname: Schneider
authors.forename: Klemens
authors.initials: K
authors.lastname: Budde
mesh_terms: D000328:Adult; D001379:Azathioprine / Q000627:therapeutic use*; D003404:Creatinine / Q000097:blood; D016572:Cyclosporine / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007677:Kidney Function Tests; D016030:Kidney Transplantation / Q000276:immunology / Q000401:mortality / Q000502:physiology*; D011247:Pregnancy; D011256:Pregnancy Outcome; D016019:Survival Analysis
chemical_list: D007166:Immunosuppressive Agents; D016572:Cyclosporine; D003404:Creatinine; D001379:Azathioprine