AST Assessment of Mycophenolate Mofetil/MPA use in Pregnant Transplant Recipients

Overview:

Transplantation offers women with end organ disease a greater chance of pregnancy. Pregnant transplant recipients must remain on immunosuppression to prevent loss of their transplant. Good transplant function, and specifically good kidney function, is very important for a successful outcome. Most information about pregnancy after transplant comes from reports of single center experience or from the National Transplantation Pregnancy Registry that was started in 1991. These reports have documented that specific birth defects appear to be associated with the use of mycophenolate mofetil/MPA in pregnancy. In reports sent to the transplant pregnancy registry, abnormalities of the bone, face, ears and brain have been reported in 26.7% of the live births to mothers treated with mycophenolate mofetil/MPA. This compares to the overall national rate of birth defects of 2.8-5%.

AST recommendation:

Pregnancy should be discussed with each female transplant candidate capable of reproduction prior to undergoing transplantation. Following transplantation, female transplant recipients treated with mycophenolate mofetil/MPA should seek counseling prior to pregnancy about their risk of transplant loss and of fetal abnormalities. If they wish to proceed with pregnancy, discontinuation of mycophenolate mofetil/MPA should be discussed and the risk of stopping mycophenolate mofetil/MPA on the transplanted organ considered. Female transplant recipients found to be pregnant while taking mycophenolate mofetil/MPA should discuss the impact of discontinuing the drug. However, a change in immunosuppressive regimen may not be feasible due to risks to the mother’s health. More research is needed about the effects of immunosuppressive medications during pregnancy and the long-term impact on the offspring.

Summary:

• Mycophenolate mofetil/MPA may cause fetal malformations.
• Female transplant recipients taking mycophenolate mofetil/MPA and either found to be pregnant or who plan to become pregnant should consider discontinuing the drug. This decision should be made in conjunction with the transplant team and take into consideration both the risk to the fetus and to the mother’s health.
• Mycophenolate mofetil/MPA has not been found to impact male transplant recipient fertility or affect their offspring.
• Continued research on the outcomes of pregnancy following transplant is needed to monitor the safety of medications and long-term outcomes of the offspring.

Approved by the AST Executive Committee on August 6, 2008
Revised and approved by the AST Board of Directors on April 13, 2009