PREDNISONE DOSAGE AND PREGNANCY OUTCOME IN RENAL-ALLOGRAFT RECIPIENTS

Background. The literature contains reports of 2309 pregnancies in som e 1600 women who have undergone renal transplantation. Certain pre-pre gnancy factors, especially hypertension, renal graft dysfunction, shor t interval between transplant and pregnancy, and high immunosuppressiv e drug dosage, appear to increase the neonatal risks. Method. We descr ibe the outcome of 42 pregnancies in 27 allograft recipients at Rabin Medical Center (Beilinson Campus) in Israel during the last 8 years. A ll were treated with combination immunosuppression regimens. Results. The average interval from transplantation to conception was 3.7 +/- 0. 4 years (2 months to 9 years), Rejection episodes occurred in 37% prio r to pregnancy but in none during or immediately after pregnancy, Twen ty-eight percent of the pregnancies ended in therapeutic or spontaneou s abortions, and 29 of the 30 deliveries ended in a live birth. The pr ematurity rate (63%) was similar to that described in the literature f or this patient group. Renal deterioration was evident in seven women (26%) within 2 years after delivery. Use of 7.5 mg/d prednisone (vs. 1 0 mg/d) before pregnancy was observed as the most significant preconce ption parameter related to better pregnancy outcome. A long interval f rom transplantation to conception and lack of pre-existing hypertensio n were also significant. Conclusion. The better pregnancy outcome asso ciated with lower prednisone dosage is probably related to the fact th at the patients selected to receive the low-dose regimen have had a lo nger and less complicated post-transplantation course.