Key result
Calcineurin inhibitor exposure during pregnancy in kidney transplant recipients increased third-trimester serum creatinine (127 vs 105 µm; P<0.01) but not low birth weight (52% vs 46%; P=0.07).
Why the study?
Does calcineurin inhibitor-based immunosuppression worsen short-term maternal and foetal outcomes in pregnant kidney transplant recipients?
Cohort (n=177)
Does calcineurin inhibitor-based immunosuppression worsen short-term maternal and foetal outcomes in pregnant kidney transplant recipients?
Absolute Event Rate: 52% vs 46%
p-value: p=0.07
Using calcineurin inhibitors during pregnancy in kidney transplant recipients causes a transient rise in third-trimester creatinine but does not negatively impact postpartum graft function or direct foetal outcomes, though all such pregnancies remain high risk.
CNI use was linked to transient creatinine rise without postpartum graft harm; leaves open questions on fetal outcomes in kidney transplant pregnancies.
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 µm; 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.
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Koenjer et al. (2021) conducted a cohort in Pregnancy in kidney transplant recipients (n=177). Calcineurin inhibitor (CNI) based immunosuppression vs. CNI-free immunosuppression was evaluated on Low birth weight (LBW) (p=0.07). Calcineurin inhibitor exposure during pregnancy in kidney transplant recipients increased third-trimester serum creatinine (127 vs 105 µm; P<0.01) but not low birth weight (52% vs 46%; P=0.07).
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