VARIABLES AFFECTING BIRTH-WEIGHT AND GRAFT-SURVIVAL IN 197 PREGNANCIES IN CYCLOSPORINE-TREATED FEMALE KIDNEY-TRANSPLANT RECIPIENTS

Outcomes fr(3)om 197 pregnancies in 141 female kidney transplant recip ients were analyzed from data collected via questionnaires, hospital r ecords, and phone interviews. All recipients were maintained on cyclos porine (CsA) before and during pregnancy. Of the livebirths, 54% were premature (<37 wk) and 50% were low-birthweight (LBW) (<2500 g). The i ncidence of recipient drug-treated hypertension (HTN) was 56%; preecla mpsia, 29%; infections and complications 22%; and rejection during pre gnancy and up to 3 mo. post delivery (rej.), 11%. Graft loss within 2 years of delivery occurred in 9% of recipients (GrL <2). No recipients reported a pregnancy after a postpregnancy graft loss. Mean serum cre atinine was reported before, during, and after pregnancy. Mean cyclosp orine doses were similar in recipients during and after pregnancy. Dat a were analyzed by logistic regression using SAS. Outcomes included pr ematurity, LBW, rej., and GrL <2. In a case-controlled study comparing a recipient group with graft dysfunction during pregnancy vs. a group with good graft function, there was a trend toward lower mean prepreg nancy CsA doses (in mg/kg) in the graft dysfunction group. A decline i n recipient graft function during pregnancy is associated with lower n ewborn birthweights and lower maternal graft survival in cyclosporine treated female kidney recipients. Pregnancy-related infections and com plications are associated with rejection and graft loss in this popula tion. Close monitoring of CsA dosing and serum creatinine levels durin g pregnancy and immediately postpartum is recommended as CsA dosage ad justment may be required.