[Pregnancy in a renal transplant patient under a triple immunosuppressive combination: cyclosporin A, azathioprine and prednisone].
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Cyclosporins
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Nephrotoxicity
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In 1978, Walcott and coworkers documented the first pregnancy in a liver transplant recipient [1]. The recipient’s immunosuppressive regimen included prednisone and azathioprine. Her pregnancy was uncomplicated, and she delivered a healthy male, weighing 2400 g, at term
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Cyclosporins
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Systemic lupus erythematosus (SLE) is an autoimmune disease that affects primarily women of childbearing age. 20-30 years ago it was common belief that SLE is exacerbated during pregnancy. Recent studies, however, could not support this notion. The likelihood of an increase in clinical activity of SLE is similar during pregnancy and in nonpregnant patients. It correlates directly with the activity of disease at the time of conception. The pregnancy outcome in patients with SLE has improved considerably in recent years. The frequency of fetal loss, however, still remains higher in SLE patients than in healthy women. In most of the cases fetal loss is due to habitual abortions, intrauterine death and premature labors. The main reasons are anti-phospholipid antibodies and the activity of SLE at the onset of pregnancy, respectively during the pregnancy. For monitoring disease activity and especially for distinguishing between the development of eclampsia and exacerbation of SLE, periodic determinations of complement proteins CH50, C3, C4 and C3d are helpful. A prophylactic therapy e.g. with prednisone in pregnant SLE patients is not justified. However, when SLE is exacerbating immunosuppressive therapy with prednisone and, if needed in combination with azathioprine, should be administered. In cases with high antiphospholipid antibody titers and prior fetal loss a treatment with low-dose acetylsalicylic acid can be considered.
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Nephrotoxicity
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Nephrotoxicity
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Cutaneous complications were studied in 120 patients who received azathioprine and prednisone for six months to ten years. Questionnaire, chart review, and physical examination were used to assess skin infections, rash, verrucae, herpes zoster, tumors, condylomata acuminata, hair loss, and color changes. One hundred patients with renal allografts were compared with 20 nontransplant patients with systemic disease. Dermatologic problems were more frequent in transplant recipients (P<.02) than in nontransplant patients. Verrucae were more frequent in transplant recipients (P<.001). There was no significant increase in the total number of skin manifestations with increasing length of therapy, although warts and herpes zoster increased with time. This study suggests that the increase in the total number of skin lesions noted in previous studies of renal transplant recipients is not as prevalent in nontransplant patients who receive azathioprine and prednisone, due primarily to fewer verrucae in nontransplant patients. (Arch Intern Med138:912-914, 1978)
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Twin Pregnancy
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Graft rejection
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