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Nephrology Dialysis Transplantation, Vol 12, Issue 4 760-763, Copyright © 1997 by Oxford University Press

ORIGINAL ARTICLES

Prednisone dosage and pregnancy outcome in renal allograft recipients

J Bar, B Fisch, C Wittenberg, I Gelerenter, G Boner and M Hod
Department of Obstetrics and Gynecology, Rabin Medical Center, Peath Tiqva, Israel.

BACKGROUND: The literature contains reports of 2309 pregnancies in some 1600 women who have undergone renal transplantation. Certain pre- pregnancy factors, especially hypertension, renal graft dysfunction, short interval between transplant and pregnancy, and high immunosuppressive drug dosage, appear to increase the neonatal risks. METHOD: We describe the outcome of 42 pregnancies in 27 allograft recipients at Rabin Medical Center (Beilinson Campus) in Israel during the last 8 years. All were treated with combination immunosuppression regimens. RESULTS: The average interval from transplantation to conception was 3.7 +/- 0.4 years (2 months to 9 years). Rejection episodes occurred in 37% prior to pregnancy but in none during or immediately after pregnancy. Twenty-eight percent of the pregnancies ended in therapeutic or spontaneous abortions, and 29 of the 30 deliveries ended in a live birth. The prematurity rate (63%) was similar to that described in the literature for this patient group. Renal deterioration was evident in seven women (26%) within 2 years after delivery. Use of 7.5 mg/d prednisone (vs. 10 mg/d) before pregnancy was observed as the most significant preconception parameter related to better pregnancy outcome. A long interval from transplantation to conception and lack of pre-existing hypertension were also significant. CONCLUSION: The better pregnancy outcome associated with lower prednisone dosage is probably related to the fact that the patients selected to receive the low-dose regimen have had a longer and less complicated post-transplantation course.
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