Pregnancy outcomes in female patients exposed to cyclosporin‐based versus tacrolimus‐based immunosuppressive regimens after liver/kidney transplantation: A systematic review and meta‐analysis

What is known and objective Pregnancy after transplantation is a challenge owing to the high risk of adverse maternal and foetal outcomes, and immunosuppressants may further impact these outcomes. There are no head‐to‐head randomized controlled trials comparing influences of cyclosporin and tacrolimus on pregnancy outcomes. Thus, we systematically reviewed and meta‐analysed observational studies assessing the comparative influences of these two drugs on pregnancy outcomes in liver/kidney transplant recipients. Methods Relevant studies comparing pregnancy outcomes with tacrolimus and cyclosporin head‐to‐head were searched in PubMed, EMBASE and Web of Science (from 1 January 2000 to 20 March 2020). The weighted mean difference and odds ratio (OR) were calculated to compare continuous and dichotomous variables, respectively, with 95% confidence intervals (CIs). Publication bias was estimated using funnel plots. The study quality was assessed according to the modified Newcastle–Ottawa scale. Results and discussion Overall, 10 observational studies of low quality, including a total of 1080 post‐liver or kidney transplant pregnancies, were identified. Tacrolimus‐treated recipients experienced a lower risk of gestational hypertension (28.0%; OR: 1.74; 95% CI: 1.27–2.39; p