Mycophenolic Acid Product Discontinuation Prior to Conception: Analysis of Pregnancies in Kidney Transplant Recipients.
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
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).
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 April 10, 2020.« Back to 2016 American Transplant Congress