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Abstract
Background Fertility is usually restored in women with renal transplants, one series noting pregnancy occurring in 12% of women at childbearing age. (1)
Tacrolimus is the primary immunosuppressant in renal transplant patients. Improved transplant outcome correlates with increasing antenatal population receiving immunosuppressive therapy (2). As pregnancy progresses, hepatic P450 cytochrome may be inhibited which thought to lead to increased serum Tacrolimus levels. We think circulating plasma volume increases and this would drop Tacrolimus levels by a dilutional effect.
Methods Retrospective analysis of notes from 2000–2012 from Renal-Obstetric clinic.
Results 15 pregnancies in 11 women on Tacrolimus recorded. Mean maternal age 30.1. Mean transplantation age 23.9 years. 5 patients had multiple renal transplants.
6 patients were primiparous (40%) and 9 multiparous (60%). Only 5 women received pre-pregnancy counselling.
10 pregnancies required increasing antenatal Tacrolimus dosing. 3 patients developed worsening renal function.
Mean gestation reached 30 weeks, with 80% of deliveries occurring <37 weeks. Live birth rate was 73.3%. 4 patients (26.7%) entered spontaneous labour, 5 (33.3%) required induction (33.3%) and 6 caesarean section deliveries (40%). Only 3 patients (20%) attended post natal follow-up within 6 weeks post-delivery.
Conclusions Our findings suggest dropping Tacrolimus levels in the late first and early second trimester, but then levels appear to gradually increase. Our live birth, IUGR and emergency caesarean rate were in consistence with rates noted in previous studies (3). More research needed looking at the effect of fluctuant Tacrolimus levels and if a drop in first trimester is associated with adverse pregnancy outcome.
References
Sturgiss SN, Davison JM. Effect of pregnancy on long-term function of renal allografts. Am J Kidney Dis 1992:167–72.
Webster AC, Woodroffe RC, Taylor RS, Chapman JR, Craig JC. Tacrolimus versus ciclosporin as primary immunosuppression for kidney transplant recipients: meta-analysis and meta-regression of randomised trial data. BMJ 2005;331:810
Pregnancy in Renal Transplant Recipients: A UK National Cohort Study CJASN CJN. K Bramham, C Nelson-Piercy, H Gao, M Pierce, N Bush, P Spark, P Brocklehurst, J Kurinczuk, M Knight.