This study analyzed 109 pregnancies (116 outcomes) in 62 female kidney-pancreas (KP) recipients reported to the Transplant Pregnancy Registry International (TPR). Data were collected via questionnaires, telephone interviews and hospital records. Of 116 outcomes there were 81 (70%) live births, 29 (25%) miscarriages, 4 (3%) terminations and 2 (2%) ectopic pregnancies. The mean transplant to conception interval was 4.3 ± 3.0 yrs. Immunosuppression during the 109 pregnancies was cyclosporine based in 46, tacrolimus based in 62 and mycophenolic acid product (MPA) monotherapy in 1. MPA exposure occurred in 25 pregnancies and sirolimus exposure in 1. Comorbid conditions during pregnancy included: hypertension 58%, infection 39%, preeclampsia 30%, and rejection 5%. Three recipients (all with adequate P function prior to pregnancy) reported insulin use during pregnancy; 2 had P graft loss during pregnancy and the other maintained P function postpartum. Mean gestational age of the live born was 34.2 ± 3.1 wks and the mean birthweight was 2142 ± 726 g. 69% of infants were delivered by Cesarean section; there was one neonatal death. Seventeen children were breastfed. All children were reported developing well at last follow-up, mean age 9.3 ± 6.6 yrs. There were 2 children diagnosed with IDDM, 4 taking medication for ADD/ADHD, and 2 required surgery (undescended testicle and atrial septal defect). There were 11.3% graft losses (4 K, 4 P and 3 KP) and no recipient deaths within 2 yrs post-delivery. At last TPR follow-up (mean 11.5 ± 7.2 yrs), maternal graft function was reported adequate in 30 recipients and 13 had varying degrees of graft dysfunction/loss. There were 19 patient deaths at mean 16.1 ± 7.7 yrs after their first transplant and their children were mean age of 11.6 ± 6.4 yrs at maternal death.

CONCLUSIONS: Pregnancy after KP transplant appears to be well tolerated, with a low incidence of rejection during pregnancy and 70% live births. Determining the impact of pregnancy on long-term maternal and graft survival in KP recipients warrants additional follow-up. We encourage all transplant centers and recipients worldwide to participate in the TPR.

CITATION INFORMATION: Rao S, Coscia L, Armenti D, Constantinescu S, Moritz M. Pregnancy After Kidney-Pancreas Transplantation: Maternal and Offspring Outcomes. Am J Transplant. 2017;17 (suppl 3).

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