Paternity in male kidney transplant recipients: a French national survey, the PATeRNAL study
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RESEARCH ARTICLE
Open Access
Paternity in male kidney transplant recipients: a French national survey, the PATeRNAL study Annabel Boyer1,2* , Thierry Lobbedez1,2,3, Mohamed Ouethrani1, Angélique Thuillier Lecouf1, Nicolas Bouvier1,3, Valérie Châtelet1,2,3, Bruno Hurault de Ligny1,3 and On behalf of the Spiesser transplant group
Abstract Background: There is concern about the impact of immunosuppressive agents taken by male kidney transplant (KT) recipients on the risk of foetal malformations. The aim of our survey was to estimate the paternity rate and the outcomes of pregnancies fathered by kidney transplanted males. Methods: This survey analysed 1332 male KT recipients older than 18 years, followed in 13 centres in France. A selfreported questionnaire was used to collect data on the patients, treatments at the time of conception and the pregnancy outcomes. Results: The study included data on 349 children from 404 pregnancies fathered by 232 male KT recipients. The paternity rate was 17% (95% CI [15–20]). There were 37 (9%, 95% CI [7–12]) spontaneous abortions, 12 (3%, 95% CI [2–5]) therapeutic abortions, 2 (0.5%, 95% CI [0.1–1]) still births, and 13 (4%, 95% CI [2–6]) malformations reported. Compared to the general population, there was no difference in the proportion of congenital malformations nor unwanted outcomes whether the father was exposed or not to immunosuppressive agents. Conclusions: This survey does not provide any warning signal that pregnancies fathered by male patients exposed to immunosuppressive agents, notably the debated MMF/MPA, have more complications than pregnancies in the general population. Keywords: Paternity, Kidney transplant, Pregnancy, Congenital malformation, Immunosuppression
Background The first child of a kidney transplant recipient was born in 1958. Pregnancy is currently considered one of the benefits accorded to women by kidney transplantation [1]. Despite early concerns about the teratogenicity of immunosuppressive medication, thousands of solid organ transplant recipients worldwide have had successful pregnancies after transplantation [2–9]. In 1991, the * Correspondence: [email protected] 1 Centre Universitaire des Maladies Rénales, CHU de Caen, Avenue de la côte de Nacre, 14033 Caen, Cedex 9, France 2 U1086 INSERME – ANTICIPE, Centre Régional de Lutte contre le Cancer, François Baclesse, 14076 Caen, Cedex 5, France Full list of author information is available at the end of the article
National Transplantation Pregnancy Registry (NTPR) was created to collect information on the outcomes of pregnancies among transplant recipients in North America [10]. Pregnancy in transplanted patients remains a challenge because of the increased risk of adverse maternal complications and adverse foetal outcomes [2–4, 7–9, 11]. In addition, immunosuppressive medications, such as sirolimus and mycophenolate mofetil/mycophenolic acid (MMF/MPA), have been associated with an increased incidence of foetal malformations [5, 6, 12–16]. A specific pattern of malformation has been descri
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