Outcomes of Pregnancies After Kidney Transplantation

Piccoli, Giorgina Barbara; Cabiddu, Gianfranca; Attini, Rossella; Gerbino, Martina; Todeschini, Paola; Perrino, Maria Luisa; Manzione, Ana Maria; Piredda, Gian Benedetto; Gnappi, Elisa; Caputo, Flavia; Montagnino, Giuseppe; Bellizzi, Vincenzo; Loreto, Pierluigi Di; Martino, Francesca; Montanaro, Domenico; Rossini, Michele; Castellino, Santina; Biolcati, Marilisa; Fassio, Federica; Loi, Valentina; Parisi, Silvia; Versino, Elisabetta; Pani, Antonello; Todros, Tullia

doi:10.1097/tp.0000000000001645

Cited by 55 publications

(28 citation statements)

References 65 publications

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“…Identification of the best candidates for pregnancy after KT is based on the results of observational studies [ 17 , 32 ]. Overall, KT pregnancy risks display behaviours similar to those found in CKD pregnancies, and the best results are in patients with normal kidney function, normotension and no proteinuria [ 9 , 17 , 30 , 32 , 51 , 56 , 114 – 120 ].…”

Section: Which Patients Are the “Best Candidates” For Pregnancy Aftermentioning

confidence: 80%

“…There is no doubt that a glomerular filtration rate (GFR) above 90 ml/min defines a normal renal function; “good” renal function is usually defined as a GFR above 60 ml/min, even if, at least according to the Italian experience, there may be significant differences between patients with GFR ≥ 90 ml/min and those with 60–90 ml/min of GFR [ 56 ].…”

Section: Evidence-based Medicine and Pregnancy After Kt: Bioethical Amentioning

confidence: 99%

“…Likewise, the definition of the cut-points for proteinuria and hypertension are non-univocal; while there is no doubt that, as well as in the overall population, blood pressure level below 130/80 is optimal and proteinuria in pregnancy is considered as normal when below 300 mg/day, there is a grey zone for blood pressure level below 140/90 and proteinuria below 300–500 mg/day [ 17 – 26 , 56 ].…”

Section: Evidence-based Medicine and Pregnancy After Kt: Bioethical Amentioning

confidence: 99%

“…There is no evidence that children from KT mothers have a higher rate of malformations than the general population, except for those linked to genetic diseases, such as congenital abnormalities of the kidneys and of the urinary tract (CAKUT) or autosomal dominant polycystic kidney disease (ADPKD) [ 17 – 21 , 23 , 56 , 95 – 100 ].…”

Section: What Are the Main Adverse Outcomes In Pregnancy In Kt Patienmentioning

confidence: 99%

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A best-practice position statement on pregnancy after kidney transplantation: focusing on the unsolved questions. The Kidney and Pregnancy Study Group of the Italian Society of Nephrology

et al. 2018

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Kidney transplantation (KT) is often considered to be the method best able to restore fertility in a woman with chronic kidney disease (CKD). However, pregnancies in KT are not devoid of risks (in particular prematurity, small for gestational age babies, and the hypertensive disorders of pregnancy). An ideal profile of the potential KT mother includes “normal” or “good” kidney function (usually defined as glomerular filtration rate, GFR ≥ 60 ml/min), scant or no proteinuria (usually defined as below 500 mg/dl), normal or well controlled blood pressure (one drug only and no sign of end-organ damage), no recent acute rejection, good compliance and low-dose immunosuppression, without the use of potentially teratogen drugs (mycophenolic acid and m-Tor inhibitors) and an interval of at least 1–2 years after transplantation. In this setting, there is little if any risk of worsening of the kidney function. Less is known about how to manage “non-ideal” situations, such as a pregnancy a short time after KT, or one in the context of hypertension or a failing kidney. The aim of this position statement by the Kidney and Pregnancy Group of the Italian Society of Nephrology is to review the literature and discuss what is known about the clinical management of CKD after KT, with particular attention to women who start a pregnancy in non-ideal conditions. While the experience in such cases is limited, the risks of worsening the renal function are probably higher in cases with markedly reduced kidney function, and in the presence of proteinuria. Well-controlled hypertension alone seems less relevant for outcomes, even if its effect is probably multiplicative if combined with low GFR and proteinuria. As in other settings of kidney disease, superimposed preeclampsia (PE) is differently defined and this impairs calculating its real incidence. No specific difference between non-teratogen immunosuppressive drugs has been shown, but calcineurin inhibitors have been associated with foetal growth restriction and low birth weight. The clinical choices in cases at high risk for malformations or kidney function impairment (pregnancies under mycophenolic acid or with severe kidney-function impairment) require merging clinical and ethical approaches in which, beside the mother and child dyad, the grafted kidney is a crucial “third element”.

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Section: Which Patients Are the “Best Candidates” For Pregnancy Aftermentioning

confidence: 80%

Section: Evidence-based Medicine and Pregnancy After Kt: Bioethical Amentioning

confidence: 99%

Section: Evidence-based Medicine and Pregnancy After Kt: Bioethical Amentioning

confidence: 99%

Section: What Are the Main Adverse Outcomes In Pregnancy In Kt Patienmentioning

confidence: 99%

See 2 more Smart Citations

A best-practice position statement on pregnancy after kidney transplantation: focusing on the unsolved questions. The Kidney and Pregnancy Study Group of the Italian Society of Nephrology

et al. 2018

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“…However, even in an ideal situation (normal kidney function, no hypertension or proteinuria, at least 2 years after transplantation, without recent rejection episodes), the risk of complications is higher in women with transplanted kidneys than in the general population. However, if teratogen drugs are avoided (mycophenolic acid and rapamycin), the outcomes of pregnancy after kidney transplantation share the same risk factors as CKD (kidney function, hypertension, and proteinuria) [59]. …”

Section: Pregnancy In Ckd Dialysis and Transplantationmentioning

confidence: 99%

What We Do and Do Not Know about Women and Kidney Diseases; Questions Unanswered and Answers Unquestioned: Reflection on World Kidney Day and International Women’s Day

et al. 2018

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Chronic kidney disease affects approximately 10% of the world’s adult population: it is within the top 20 causes of death worldwide, and its impact on patients and their families can be devastating. World Kidney Day and International Women’s Day in 2018 coincide, thus offering an opportunity to reflect on the importance of women’s health and specifically their kidney health, on the community and the next generations, as well as to strive to be more curious about the unique aspects of kidney disease in women so that we may apply those learnings more broadly. Girls and women, who make up approximately 50% of the world’s population, are important contributors to society and their families. Gender differences continue to exist around the world in access to education, medical care, and participation in clinical studies. Pregnancy is a unique state for women, offering an opportunity for diagnosis of kidney disease, but also a state where acute and chronic kidney diseases may manifest, and which may impact future generations with respect to kidney health. There are various autoimmune and other conditions that are more likely to have an impact on women, with profound consequences for child bearing, and on the fetus. Women have different complications on dialysis than men, and are more likely to be donors than recipients of kidney transplants. In this editorial, we focus on what we do and do not know about women, kidney health, and kidney disease, and what we might learn in the future to improve outcomes worldwide.

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Adverse Pregnancy Outcomes in Solid Organ Transplant Recipients

Yo,

Fields,

et al. 2024

JAMA Netw Open

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ImportanceTransplant recipients experience high rates of adverse pregnancy outcomes; however, contemporary estimates of the association between solid organ transplantation and adverse pregnancy outcomes are lacking.ObjectiveTo evaluate the association between solid organ transplantation and adverse pregnancy outcomes and to quantify the incidence of allograft rejection and allograft loss during pregnancy.Data SourcesPubMed/MEDLINE, EMBASE and Scopus databases were searched from January 1, 2000, to June 20, 2024, and reference lists were manually reviewed.Study SelectionCohort and case-control studies that reported at least 1 adverse pregnancy outcome in pregnant women with solid organ transplantation vs without solid organ transplant or studies that reported allograft outcomes in pregnant women with solid organ transplantation were included following independent dual review of abstracts and full-text articles.Data Extraction and SynthesisTwo investigators abstracted data and independently appraised risk of bias using the Newcastle Ottawa Scale. A random-effects model was used to calculate overall pooled estimates using the DerSimonian-Laird estimator. Reporting followed the Meta-analysis of Observational Studies in Epidemiology (MOOSE) reporting guideline.Main Outcomes and MeasuresPrimary pregnancy outcomes were preeclampsia, preterm birth (&lt;37 weeks), and low birth weight (&lt;2500 g). Secondary pregnancy outcomes were live birth rate, gestation, very preterm birth (&lt;32 weeks), very low birth weight (&lt;1500 g), and cesarean delivery. Allograft outcomes were allograft loss and rejection during pregnancy.ResultsData from 22 studies and 93 565 343 pregnancies (4786 pregnancies in solid organ transplant recipients) were included; 14 studies reported adverse pregnancy outcomes, and 13 studies provided data for allograft outcomes. Pregnancies in organ transplant recipients were associated with significantly increased risk of preeclampsia (adjusted odds ratio [aOR], 5.83 [95% CI, 3.45-9.87]; I2 = 77.4%), preterm birth (aOR, 6.65 [95% CI, 4.09-12.83]; I2 = 81.8%), and low birth weight (aOR, 6.51 [95% CI, 2.85-14.88]; I2 = 90.6%). The incidence of acute allograft rejection was 2.39% (95% CI, 1.20%-3.96%; I2 = 68.5%), and the incidence of allograft loss during pregnancy was 1.55% (95% CI, 0.05%-4.44%; I2 = 69.2%).Conclusions and RelevanceIn this systematic review and meta-analysis, pregnancies in recipients of a solid organ transplant were associated with a 4 to 6 times increased risk of preeclampsia, preterm birth, and low birth weight during pregnancy. There was a low overall risk of graft rejection or loss during pregnancy.

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Outcomes of Pregnancies After Kidney Transplantation

Abstract: The maternofetal outcomes in patients with kidney transplantation are comparable with those of nontransplanted CKD patients with similar levels of kidney function impairment and progressive and/or immunologic kidney disease.

Cited by 55 publications

References 65 publications

A best-practice position statement on pregnancy after kidney transplantation: focusing on the unsolved questions. The Kidney and Pregnancy Study Group of the Italian Society of Nephrology

A best-practice position statement on pregnancy after kidney transplantation: focusing on the unsolved questions. The Kidney and Pregnancy Study Group of the Italian Society of Nephrology

What We Do and Do Not Know about Women and Kidney Diseases; Questions Unanswered and Answers Unquestioned: Reflection on World Kidney Day and International Women’s Day

Adverse Pregnancy Outcomes in Solid Organ Transplant Recipients

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