skip to main content

Pregnancy Post-Transplant — ESENeph MCQ

Instant feedback + full explanation. One question, done properly.

EasyTransplantationPregnancy Post-TransplantESENeph

A 43-year-old woman is 2 years post-living donor kidney transplant. She wishes to become pregnant. Her eGFR is 55 mL/min/1.73m2, proteinuria is minimal, and BP is 120/74 mmHg. She is on Tacrolimus, Mycophenolate mofetil, and Prednisolone 5 mg. What medication change is essential before conception?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: A — Stop Mycophenolate mofetil and switch to Azathioprine at least 6 weeks before conception

Mycophenolate mofetil (and mycophenolic acid) is teratogenic and must be stopped at least 6 weeks before planned conception. It should be switched to Azathioprine, which is considered safe in pregnancy. Tacrolimus can be continued (with trough monitoring as levels may change in pregnancy). Low-dose Prednisolone is safe. KDIGO 2009 and UKKA pregnancy guidelines mandate MMF discontinuation before conception.

Reference: KDIGO 2009 – Transplant Guideline; UKKA 2019 – Pregnancy in CKD