Immunodrugs Compared On Pregnancy Outcomes


WASHINGTON—Perinatal outcomes were slightly, but not significantly, better in renal transplant recipients who were immunosuppressed with cyclosporine, compared with those given azathioprine, according to findings from a study involving 59 pregnant women at a single research center.

“There are no described rates of maternal mortality for women with renal transplants,” noted Dr. Vicenç Cararach, who presented study results at the annual meeting of the International Society of Obstetric Medicine.

Dr. Cararach and colleagues at the University of Barcelona compared 27 patients who were treated with azathioprine and prednisone (1973–1991) and 32 patients who were treated with cyclosporine and prednisone (1992–2007).

Overall, 3 patients (11%) in the azathioprine group and 2 patients (6%) in the cyclosporine group delivered at less than 32 weeks' gestation. An average of 13 infants in each group had birth weights below 2500 grams.

There were no maternal deaths in either group, and the three reported perinatal deaths all occurred in the azathioprine group.

More cases of premature rupture of membranes occurred in the azathioprine group, while more cases of preeclampsia and intrauterine growth restriction were found in the cyclosporine group.

Although these differences were not significant because of the limited number of cases, “it does not mean that they were not clinically important,” Dr. Cararach noted.

Creatinine levels during pregnancy were similar between the two groups, he said. However, 3 years after pregnancy, creatinine levels were higher in the cyclosporine group, which raises some concerns about renal function with long-term cyclosporine use, Dr. Cararach added.

The results support those from previous studies demonstrating that perinatal outcomes are generally positive among renal transplant recipients, he said.

However, the elevated risk of premature birth remains a concern. And there are long-term risks for hypertension and infection that deserve further study, he noted.

Dr. Cararach stated that he had no financial conflicts of interest.

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