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Mycophenolic Acid Product Discontinuation Prior to Conception: Analysis of Pregnancies in Kidney Transplant Recipients.

S. Constantinescu,1,2 L. Coscia,2 D. Armenti,2 M. Moritz.2,3

1Medicine, Temple University, Philadelphia, PA
2Gift of Life Institute, National Transplantation Pregnancy Registry (NTPR), Philadelphia, PA
3Surgery, Lehigh Valley Health Network, Allentown, PA.

Meeting: 2016 American Transplant Congress

Abstract number: 66

Keywords: Immunosuppression, Kidney transplantation, Pregnancy

Session Information

Date: Sunday, June 12, 2016

Session Name: Concurrent Session: Policy and Practice: Implications for Long Term Outcomes

Session Time: 2:30pm-4:00pm

 Presentation Time: 3:18pm-3:30pm

Location: Room 312

Related Abstracts
  • Pregnancy Outcomes in Solid Organ Transplant Recipients with a Switch from a Mycophenolic Acid Product to Azathioprine Prior to Conception
  • What if Mycophenolic Acid Product Is Discontinued Less Than 6 Weeks Before Pregnancy?

Mycophenolic acid (MPA) products are considered teratogenic and transplant centers report discontinuing MPA in female kidney recipients anticipating pregnancy. Data were collected by the National Transplantation Pregnancy Registry (NTPR) via questionnaires, phone interviews and medical records. 142 pregnancies were conceived on MPA, and in 302 pregnancies MPA was discontinued preconception.

  MPA exposure during pregnancy MPA discontinued before conception p value
Recipients/Pregnancies 96/142 188/302  
Unplanned pregnancies 59% 15% <0.001
Conception Age (yrs) 29.1±4.6 31.9±4.6 <0.001
Transplant to conception interval (yrs) 3.9±2.8 5.6±3.7 <0.001
Creatinine before pregnancy (mg/dL) 1.3±0.4 1.1±0.3 <0.001
Creatinine during 1.4±0.8 1.2±0.6 0.006
Creatinine postpartum 1.5±0.8 1.2±0.5 <0.001
Biopsy proven acute rejection during 4.3% 1.3% 0.08
Biopsy proven acute rejection postpartum 5.1% 1.4% 0.04
Pregnancy Outcomes      
Live births 48% 78% <0.001
Miscarriages 48% 20% <0.001
Stillbirths 1% 1% NS
Ectopic pregnancies 0 1% NS
Terminations 3% 0.3% NS
Live births 69 246  
Mean gestational age (wks) 35.3±3.3 35.7±3.5 NS
Premature (<37 wks) 55% 48% NS
Mean birthweight (g) 2406±759 2549±756 0.07
Low birthweight (<2500 g) 49% 39% NS
Birth defects (live born) 11.6%* 5.7% NS
*Includes 61% MPA-related defects. Percentage does not include MPA-related defects found in 1 stillbirth and 1 termination.      

Recipients who discontinued MPA preconception had significantly longer transplant to conception intervals and lower creatinine levels before, during and after pregnancy. These pregnancies resulted in a significantly higher rate of live births and lower incidence of birth defects. Acute rejection rates during pregnancy and postpartum were slightly higher in the MPA exposed group.

Conclusions: Compared to kidney recipients who remained on MPA in early pregnancy, those who discontinued MPA preconception had a significantly higher rate of live births with an incidence of birth defects similar to the general population. There was no increase in acute rejections during pregnancy or postpartum in the group of recipients who discontinued MPA.

CITATION INFORMATION: Constantinescu S, Coscia L, Armenti D, Moritz M. Mycophenolic Acid Product Discontinuation Prior to Conception: Analysis of Pregnancies in Kidney Transplant Recipients. Am J Transplant. 2016;16 (suppl 3).

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To cite this abstract in AMA style:

Constantinescu S, Coscia L, Armenti D, Moritz M. Mycophenolic Acid Product Discontinuation Prior to Conception: Analysis of Pregnancies in Kidney Transplant Recipients. [abstract]. Am J Transplant. 2016; 16 (suppl 3). https://atcmeetingabstracts.com/abstract/mycophenolic-acid-product-discontinuation-prior-to-conception-analysis-of-pregnancies-in-kidney-transplant-recipients/. Accessed March 6, 2021.

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