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Pregnancy outcomes and impact of pregnancy on graft function in women after kidney transplantation
Author(s) -
Mohammadi F.A.,
Borg M.,
Gulyani A.,
McDonald S.P.,
Jesudason S.
Publication year - 2017
Publication title -
clinical transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 76
eISSN - 1399-0012
pISSN - 0902-0063
DOI - 10.1111/ctr.13089
Subject(s) - medicine , pregnancy , interquartile range , obstetrics , transplantation , kidney transplantation , creatinine , renal function , eclampsia , gestation , gynecology , surgery , genetics , biology
Background Kidney transplantation facilitates pregnancy in women with end‐stage kidney disease; however, the impact of pregnancy on short and longer‐term graft function is uncertain. Methods Obstetric, fetal, and graft outcomes for pregnancies from a large Australian transplant unit (1976‐2015) were reviewed. Results There were 56 pregnancies in 35 women with mean age at conception 30.4 ± 0.6 years and mean transplant‐pregnancy interval 5.5 ± 0.5 years. The live birth rate was 78.9%. Preterm birth (<37 weeks) occurred in 56.5%. Hypertensive disorders affected 76% of women (pre‐eclampsia in 30%). Median prepregnancy serum creatinine ( SC r) was 100 μmol/L (interquartile range (IQR), 80, 114 μmol/L). One‐third had deterioration in graft dysfunction during pregnancy; of these, 63.2% did not return to baseline. At 2 years post‐partum, median SCr was 96.4 μmol/L (IQR, 81.5‐124.3). Women with prepregnancy SC r > 110 μmol/L had increased risk of pre‐eclampsia ( OR 4.4; 95% CI 1.2‐16.8; P = .03), but not preterm birth ( OR 5.4; 95% CI 0.5‐53; P = .04) or low birth‐weight babies ( OR 1.2; 95% CI 0.5‐2.9; P = .04). Women with SC r > 140 μmol/L preconception had worst SC r trajectory, including higher rates of graft loss. Conclusions Kidney transplantation pregnancies remain at high risk of obstetric complications, particularly pre‐eclampsia. Prepregnancy graft function can be used to predict risk of adverse pregnancy outcomes and deterioration in graft function during and after delivery.