Preconception Immunosuppression Regimens and Perinatal Outcomes in Renal Transplant Recipients [A158

Abstract

INTRODUCTION: Renal transplant recipients are frequently transitioned to new immunosuppression regimens (ISR) in anticipation of pregnancy to reduce teratogenic risks. The consequent effects on perinatal outcomes and renal allograft condition are not known. We evaluated the risks of transitioning to a new ISR in the preconception period on perinatal outcomes and allograft condition in renal transplant recipients. METHODS: Institutional review board approval was obtained for the study. A retrospective cohort study at a single tertiary-care center included all pregnancies with a history of renal transplant between January 1995 and 2021. Patients who did not have a pregnancy following their transplant or who were still pregnant at the time of data analysis were excluded. Study groups included patients who transitioned to a new ISR prior to pregnancy versus patients who continued on their established ISR. RESULTS: Of 93 pregnancies identified, 27 patients, with a total of 30 pregnancies, met inclusion criteria. Preconception ISR transition occurred in 13 pregnancies (48.1%). There were no significant differences in maternal characteristics between groups. Preconception ISR transition was associated with a significantly later gestational age at delivery (36.0 versus 30.9, P=.02) and a non-statistically-significant higher live birth rate (84.6% versus 52.9%, P=.07). Overall, maternal and fetal composite adverse outcomes and acute renal injury in pregnancy did not differ between groups. CONCLUSION: Transitioning patients to a new ISR in the preconception period did not significantly affect perinatal outcomes or allograft condition in pregnancy; however, women may deliver at a later gestational age. Additional studies are needed to further investigate this association.