Open AccessComparison of pregnancy outcomes in Dutch kidney recipients with and without calcineurin inhibitor exposure: a retrospective study
Author(s) -
Koenjer Lisanne M.,
Meinderts Jildau R.,
Heijden Olivier W. H.,
Lely Titia,
Jong Margriet F. C.,
Molen Renate G.,
Hamersvelt Henk W.
Publication year - 2021
Publication title -
transplant international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.998
H-Index - 82
eISSN - 1432-2277
pISSN - 0934-0874
DOI - 10.1111/tri.14156
Subject(s) - medicine , calcineurin , pregnancy , creatinine , urology , renal function , retrospective cohort study , immunosuppression , kidney transplantation , obstetrics , transplantation , genetics , biology
Summary Within pregnancies occurring between 1986 and 2017 in Dutch kidney transplant recipients (KTR), we retrospectively compared short‐term maternal and foetal outcomes between patients on calcineurin inhibitor (CNI) based (CNI+) and CNI‐free immunosuppression (CNI−). We identified 129 CNI+ and 125 CNI− pregnancies in 177 KTR. Demographics differed with CNI+ having higher body mass index ( P = 0.045), shorter transplant‐pregnancy interval ( P < 0.01), later year of transplantation and ‐pregnancy ( P < 0.01). Serum creatinine levels were numerically higher in CNI+ in all study phases, but only reached statistical significance in third trimester (127 vs. 105 µ m ; P < 0.01), where the percentual changes from preconceptional level also differed (+3.1% vs. −2.2% in CNI−; P = 0.05). Postpartum both groups showed 11–12% serum creatinine rise from preconceptional level. Incidence of low birth weight (LBW) tended to be higher in CNI+ (52% vs. 46%; P = 0.07). Both groups showed equal high rates of preterm delivery. Using CNIs during pregnancy lead to a rise in creatinine in the third trimester but does not negatively influence the course of graft function in the first year postpartum or direct foetal outcomes. High rates of preterm delivery and LBW in KTR, irrespective of CNI use, classify all pregnancies as high risk.