The purpose of this study was to analyze pregnancy outcomes in female transplant recipients who switched their immunosuppressive regimen from a mycophenolic acid product (MPA) to azathioprine (AZA) >6 wks prior to conception. The FDA pregnancy category for MPA was changed from C to D in 2007. Many centers report switching female recipients to AZA prior to conception, despite the fact that AZA also is designated FDA category D. Data were collected by the National Transplantation Pregnancy Registry (NTPR) via questionnaires, phone interviews and records review. Overall, 69 recipients (71 pregnancies, 74 outcomes) switched their regimen from MPA to AZA in anticipation of conceiving. Of those, 56 recipients (46 kidney, 7 pancreas-kidney [PK], 2 heart, 1 lung) conceived 58 pregnancies after switching from MPA to AZA >6 weeks prior to conception. Pregnancy outcomes included 51 live births (88%), 4 spontaneous abortions (7%), 2 stillbirths, and 1 therapeutic abortion. The stillbirths were associated with placenta previa and tetraploidy, respectively. Birth defects reported were familial club foot (2) and hypospadias (2). At last follow-up, all children were reported healthy and developing well. Half of the recipients resumed MPA postpartum. At last maternal follow-up, 2 (4%) kidney recipients reported graft loss within 2 yrs of delivery (remained on AZA), 1 PK recipient lost P function during pregnancy and the remaining 53 recipients reported adequate graft function.
Conclusions: Switching from MPA to AZA >6 wks prior to conception can result in successful pregnancy outcomes without increased incidence of graft loss within 2 yrs of delivery. In this study group, 4% of kidney recipients lost their graft versus the NTPR-reported graft loss of 6-8% within 2 yrs of delivery in kidney recipients. This group also does not exhibit the increased spontaneous abortion rate or pattern of birth defects (microtia, cleft lip and palate) found in pregnancies conceived by transplant recipients who take MPA during their pregnancy.
Coscia, L.: Grant/Research Support, Novartis Pharmaceuticals Corp. Astellas Pharma US, Inc. Genentech, Inc. Pfizer Inc. Bristol-Myers Squibb, Sandoz and Teva. Armenti, V.: Grant/Research Support, Novartis Pharmaceuticals Corp. Astellas Pharma US, Inc. Genentech, Inc. Pfizer Inc. Bristol-Myers Squibb, Sandoz and Teva.
To cite this abstract in AMA style:Sifontis N, Coscia L, Lundgren M, Dharbhamulla N, Constantinescu S, Moritz M, McGrory C, Ramirez C, Armenti V. Pregnancy Outcomes in Solid Organ Transplant Recipients with a Switch from a Mycophenolic Acid Product to Azathioprine Prior to Conception [abstract]. Am J Transplant. 2013; 13 (suppl 5). https://atcmeetingabstracts.com/abstract/pregnancy-outcomes-in-solid-organ-transplant-recipients-with-a-switch-from-a-mycophenolic-acid-product-to-azathioprine-prior-to-conception/. Accessed June 14, 2021.
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