Pregnancy and Maternal Outcomes Among Kidney Transplant Recipients

Abstract

Fertility rates, pregnancy, and maternal outcomes are not well described among women with a functioning kidney transplant. Using data from the Australian and New Zealand Dialysis and Transplant Registry, we analyzed 40 yr of pregnancy-related outcomes for transplant recipients. This analysis included 444 live births reported from 577 pregnancies; the absolute but not relative fertility rate fell during these four decades. Of pregnancies achieved, 97% were beyond the first year after transplantation. The mean age at the time of pregnancy was 29 Ϯ 5 yr. Compared with previous decades, the mean age during the last decade increased significantly to 32 yr (P Ͻ 0.001). The proportion of live births doubled during the last decade, whereas surgical terminations declined (P Ͻ 0.001). The fertility rate (or live-birth rate) for this cohort of women was 0.19 (95% confidence interval 0.17 to 0.21) relative to the Australian background population. We also matched 120 parous with 120 nulliparous women by year of transplantation, duration of transplant, age at transplantation Ϯ5 yr, and predelivery creatinine for parous women or serum creatinine for nulliparous women; a first live birth was not associated with a poorer 20-yr graft or patient survival. Maternal complications included preeclampsia in 27% and gestational diabetes in 1%. Taken together, these data confirm that a live birth in women with a functioning graft does not have an adverse impact on graft and patient survival.

Timing of Pregnancy After Kidney Transplantation and Risk of Allograft Failure

“…A number of studies comparing allograft survival among pregnant and matched nonpregnant controls found no statistically significant difference in allograft survival between these groups (4,(20)(21)(22)(23)). An analysis of the Australian and New Zealand Dialysis and Transplant Registry reported no difference in 20-year allograft or patient survival between 120 patients who became pregnant after transplantation compared to matched controls (24). Although this study was not limited by voluntary patient participation, it only included pregnancies resulting in live births, and the timing of pregnancy after transplantation was likely later (median 67 months after ESRD start) than in the pregnancies included in our study (24).…”

“…An analysis of the Australian and New Zealand Dialysis and Transplant Registry reported no difference in 20-year allograft or patient survival between 120 patients who became pregnant after transplantation compared to matched controls (24). Although this study was not limited by voluntary patient participation, it only included pregnancies resulting in live births, and the timing of pregnancy after transplantation was likely later (median 67 months after ESRD start) than in the pregnancies included in our study (24). Overall, 32% of pregnancies in our study ended in early pregnancy loss (i.e.…”

Pregnancy in Renal Transplant Recipients

“…In our study, only 3% (a similar proportion to the comparison group) of women developed GDM despite over half taking tacrolimus. Others have also reported low rates of GDM in transplant recipients (4,9), which may be a consequence of different diagnostic blood glucose levels between studies, or the ethnicity of the populations included, but is otherwise unexplained.…”

“…Most studies reporting pregnancy outcome in women with kidney transplants are single-centerbased and retrospective, may span $2 decades, and the majority include ,50 pregnancies (4,5). Four voluntary registers have collected data (6)(7)(8)(9) in larger numbers of women, but are reliant on self-reporting.…”

A Retrospective Analysis of Pregnancy Outcomes after Kidney Transplantation in a Single Center

“…This statement is also true for renal transplantation. Although graft survival is quite common during pregnancy, transplant recipients are at a higher risk of obstetric complications, namely, hypertension, urinary tract infections, graft rejection, anemia and gestational diabetes [12,32,33]. Preeclampsia, which does not have any prophylactic interventions to reduce its incidence, develops in more than a quarter of pregnant renal transplant patients, but the diagnosis is difficult in patients who already may have hypertension and proteinuria [34].…”