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BMC Nephrol. 2019 May 14;20(1):161. doi: 10.1186/s12882-019-1346-6.

Effect of deflazacort on pregnancy outcome in kidney transplant patients: should we change the immunosuppressant before conception?

Yun BH1,2, Joo DJ3, Seo SK4,5, Cho SH2,6, Choi YS1,2, Lee BS7,8.

Author information

1
Department of Obstetrics and Gynecology, Severance Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.
2
Institute of Women's Life Medical Science, Yonsei University College of Medicine, Seoul, Republic of Korea.
3
Department of Transplant Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
4
Department of Obstetrics and Gynecology, Severance Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea. tudeolseo@yuhs.ac.
5
Institute of Women's Life Medical Science, Yonsei University College of Medicine, Seoul, Republic of Korea. tudeolseo@yuhs.ac.
6
Department of Obstetrics and Gynecology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
7
Department of Obstetrics and Gynecology, Severance Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea. dr222@yuhs.ac.
8
Institute of Women's Life Medical Science, Yonsei University College of Medicine, Seoul, Republic of Korea. dr222@yuhs.ac.

Abstract

BACKGROUND:

Despite the good prognosis in patients with transplant organs, limited evidence is available on how immunosuppressants affect pregnancy. The aim of this study was to determine whether immunosuppressant use affects the pregnancy outcome and to identify whether there is any need to change the immunosuppressant before the patient tries to conceive.

METHODS:

This retrospective cohort study included women with previous kidney transplantation history who visited the Department of Obstetrics and Gynecology for either infertility or antenatal care between January 2005 and May 2016. A total of 40 cases (36 women) met the inclusion criteria. Statistical analyses were performed using SAS version 9.4.

RESULTS:

There were no differences in the immunosuppressant regimen between the pregnant and non-pregnant groups (never-pregnant+miscarriage) (P = 0.73). Individual immunosuppressant use was significantly different in terms of pregnancy outcome among the never-pregnant, miscarriage, and clinical pregnancy groups (azathioprine, P = 0.01; deflazacort, P < 0.0001). Only deflazacort use differed significantly between the clinical pregnancy and non-pregnant groups (P = 0.003). After adjusting for factors that may affect pregnancy outcome, deflazacort use remained significantly associated with a decreased odds ratio for clinical pregnancy (P = 0.02). Cox regression analysis also showed that deflazacort use was the only remaining factor that could hinder the success of clinical pregnancy (P = 0.03).

CONCLUSIONS:

Our study suggests that the type of immunosuppressive regimen may not affect the success of clinical pregnancy. However, deflazacort may decrease the possibility of clinical pregnancy in women with kidney transplant when they try to conceive.

KEYWORDS:

Immunosuppressant; Kidney transplant; Pregnancy

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