title: The optimal therapy of calcineurin inhibitors for pregnancy in kidney transplantation.
abstract: We investigated the effects of pregnancy and delivery on renal function in transplant recipients and the relationship between doses of immunosuppressants and blood drug levels during pregnancy in 75 women with 88 deliveries. Significant serum creatinine elevation (> 0.5 mg/dL) was found in eight deliveries. In the remaining 80 cases, serum creatinine was reduced by an average of 0.14 mg/dL and returned to pre-pregnant levels after delivery. Tacrolimus was used in 28 deliveries and cyclosporine in others. Tacrolimus blood trough level declined from 5.8 ± 2.8 ng/mL 12 months before delivery to 4.2 ± 1.8 ng/mL at second trimester; therefore, drug dose was increased from 4.1 ± 1.9 mg/d at first trimester to 5.5 ± 2.5 mg/d at delivery. Similarly, cyclosporine levels were 125.1 ± 65.1 ng/mL 12 months before delivery and 75.4 ± 35.0 ng/mL at second trimester resulting in dose elevation from 183.0 ± 71.8 mg/d at first trimester to 225.4 ± 85.1 mg/d at delivery. Renal function in female kidney transplant recipients improved slightly during pregnancy and returned to pre-pregnant level after delivery. The dose elevation of calcineurin inhibitor by approximately 20-25% should be considered during gestational period to maintain optimal blood drug level.
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Hyosang
authors.initials: H
authors.lastname: Kim
authors.forename: Jong Cheol
authors.initials: JC
authors.lastname: Jeong
authors.forename: Jaeseok
authors.initials: J
authors.lastname: Yang
authors.forename: Won Seok
authors.initials: WS
authors.lastname: Yang
authors.forename: Curie
authors.initials: C
authors.lastname: Ahn
authors.forename: Duck Jong
authors.initials: DJ
authors.lastname: Han
authors.forename: Jung Sik
authors.initials: JS
authors.lastname: Park
authors.forename: Su-Kil
authors.initials: SK
authors.lastname: Park
mesh_terms: D000328:Adult; D065095:Calcineurin Inhibitors / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000188:drug therapy*; D006801:Humans; D007231:Infant, Newborn; D016030:Kidney Transplantation; D008297:Male; D011247:Pregnancy; D011248:Pregnancy Complications; D011256:Pregnancy Outcome; D012189:Retrospective Studies
chemical_list: D065095:Calcineurin Inhibitors
keywords: cyclosporine; kidney; pregnancy; tacrolimus; transplantation