This is the first series report of pregnancies after pancreas transplant alone (PTA). Data were collected by the Transplant Pregnancy Registry International (TPR) via questionnaires, telephone interviews, and medical records review. The purpose of this study was to analyze 11 pregnancies in 6 PTA recipients. The 6 recipients had insulin-dependent diabetes for a mean of 21 yrs prior to PTA. The mean recipient age at 1^st transplant was 31.9±4.8 yrs with a mean conception age of 35.3±3.7 yrs. Tacrolimus was the primary immunosuppression agent during all pregnancies. Adjunctive immunosuppressive agents included azathioprine in 91% and mycophenolic acid product (MPA) exposure in 9%. Co-morbidities during pregnancy included pre-eclampsia (33%) and hypertension (27%). There were no reported cases of insulin use during pregnancy or transplant rejection. One recipient had postpartum rejection (not biopsied) with improved function after restarting MPA. Two recipients had graft loss within 2 years of delivery. According to SRTR data, 5-year graft survival for female PTA recipients is 55%. At last TPR follow-up of the 6 study recipients, at a mean of 5.3 yrs post-delivery, 3 recipients had graft loss (1 retransplanted), 1 recipient died with adequate pancreas function due to large B cell lymphoma, and 2 have maintained their pancreas function. The pregnancies resulted in 6 live births and 5 miscarriages (1 MPA exposure). Of note, after 2 posttransplant miscarriages 1 recipient had 2 live born via gestational carrier, using her ova (not counted amongst the live born). Of the 6 live births in PTA recipients the mean gestational age was 36.7±2.8 wks and the mean birth weight was 2622±465 g. No birth defects were reported. At last follow-up at a mean age of 3 yrs, all 6 children were reported healthy and developing well with no reports of insulin dependent diabetes.

Conclusions: Successful pregnancy after PTA is possible with no rejection or insulin use during pregnancy. The impact of pregnancy on postpartum graft survival warrants further study.

CITATION INFORMATION: Patel P., Kliniewski D., Coscia L., Armenti D., Constantinescu S., Moritz M. Pregnancies in Female Pancreas Transplant Alone Recipients Am J Transplant. 2017;17 (suppl 3).

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