Prednisone dosage and pregnancy outcome in renal allograft recipients

Background: The literature contains reports of 2309 pregnancies in some 1600 women who have undergone renal transplantation. Certain pre-pregnancy factors, especially hypertension, renal graft dysfunction, short interval between transplant and pregnancy, and high immunosuppressive drug dosage, appear to increase the neonatal risks. Method: We describe the outcome of 42 pregnancies in 27 allograft recipients at Rabin Medical Center (Beilinson Campus) in Israel during the last 8 years. All 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% prior to pregnancy but in none during or immediately after pregnancy. Twenty-eight percent of the pregnancies ended in therapeutic or spontaneous abortions, and 29 of the 30 deliveries ended in a live birth. The prematurity rate (63%) was similar to that described in the literature for this patient group. Renal deterioration was evident in seven women (26%) within 2 years after delivery. Use of 7.5 mg/d prednisone (vs. 10 mg/d) before pregnancy was observed as the most significant preconception parameter related to better pregnancy outcome. A long interval from transplantation to conception and lack of pre-existing hypertension were also significant. Conclusion: The better pregnancy outcome associated with lower prednisone dosage is probably related to the fact that the patients selected to receive the low-dose regimen have had a longer and less complicated post-transplantation course.