A nationwide Dutch cohort study shows relatively good pregnancy outcomes after kidney transplantation and finds risk factors for adverse outcomes

Gosselink, Margriet; Buren, Marleen van; Kooiman, Judith; Groen, Henk; Ganzevoort, Wessel; Hamersvelt, Henk W. van; Heijden, Olivier W.H. van der; Wetering, Jacqueline van de; Lely, Titia

doi:10.1016/j.kint.2022.06.006

Cited by 19 publications

(23 citation statements)

References 60 publications

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“…Indeed, Gosselink et al 7 report both an increase over time in the number of pregnancies and a decrease in the prepregnancy allograft function. This highlights how the long-retained dogma, on which most of the guidelines for the management of pregnancy after kidney transplantation are modeled, is being cautiously ignored, in favor of assisting women to achieve motherhood.…”

mentioning

confidence: 99%

Pregnancy outcomes after kidney transplantation: the challenges of success

Jesudason¹,

Piccoli

2022

Kidney International

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confidence: 99%

Pregnancy outcomes after kidney transplantation: the challenges of success

Jesudason¹,

Piccoli

2022

Kidney International

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“…Bramham et al did not see a correlation with adverse pregnancy outcomes despite the absence of a fall in creatinine in post-transplant pregnancies [ 6 ]. In contrast, Gosselink et al showed, from a recent large nationwide cohort study with 177 patients, that a midterm percentage serum creatinine dip was significantly smaller in pregnancies with an adverse pregnancy outcome (mean difference of −4.5%) [ 49 ]. Our study also demonstrates that hyperfiltration (indicating the capacity to increase eGFR during pregnancy) occurred significantly more often and was more pronounced in the group with stable kidney function and in women without adverse pregnancy events.…”

Section: Discussionmentioning

confidence: 99%

Pregnancy after Kidney Transplantation—Impact of Functional Renal Reserve, Slope of eGFR before Pregnancy, and Intensity of Immunosuppression on Kidney Function and Maternal Health

Kaatz

Latartara

Bachmann

et al. 2023

JCM

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Women of childbearing age show increased fertility after kidney transplantation. Of concern, preeclampsia, preterm delivery, and allograft dysfunction contribute to maternal and perinatal morbidity and mortality. We performed a retrospective single-center study, including 40 women with post-transplant pregnancies after single or combined pancreas–kidney transplantation between 2003 and 2019. Outcomes of kidney function up to 24 months after the end of pregnancy were compared with a matched-pair cohort of 40 transplanted patients without pregnancies. With a maternal survival rate of 100%, 39 out of 46 pregnancies ended up with a live-born baby. The eGFR slopes to the end of 24 months follow-up showed mean eGFR declines in both groups (−5.4 ± 14.3 mL/min in pregnant versus −7.6 ± 14.1 mL/min in controls). We identified 18 women with adverse pregnancy events, defined as preeclampsia with severe end-organ dysfunction. An impaired hyperfiltration during pregnancy was a significant risk contributor for both adverse pregnancy events (p < 0.05) and deterioration of kidney function (p < 0.01). In addition, a declining renal allograft function in the year before pregnancy was a negative predictor of worsening allograft function after 24 months of follow-up. No increased frequency of de novo donor-specific antibodies after delivery could be detected. Overall, pregnancies in women after kidney transplantation showed good allograft and maternal outcomes.

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“…The prevalence of maternal, perinatal, and obstetric complications in pregnancies after kidney transplantation is significantly higher. 3,4 The higher rate of preeclampsia in pregnancies postkidney transplant is well established and was reported in a recent meta-analysis at 21.5%, 3 substantially higher than 3% observed in the general Australian birth population. 5 As a multisystem disorder of pregnancy, preeclampsia worsens perinatal outcomes 6 and is independently associated with future cardiovascular disease and kidney failure.…”

Section: Introductionmentioning

confidence: 95%

“…Studies of postkidney transplant pregnancy from the Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry and other countries have reported no clear association between pregnancy and longer-term reduced graft function and survival. 4,[8][9][10] However, graft function and outcomes in the subset of transplanted women who develop preeclampsia have been minimally defined. 8 The relationship between preconception kidney function, potential preeclampsia exposure, and longer-term graft function and survival is crucial in preconception risk stratification and needs to be understood to guide informed shared decision making.…”

Section: Introductionmentioning

confidence: 99%

Preeclampsia after Kidney Transplantation

Hewawasam

Davies

et al. 2023

CJASN

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Background: Transplanted women have high rates of pre-eclampsia. However, determinants of pre-eclampsia and association with graft survival and function remain uncertain. We aimed to determine rates of pre-eclampsia and its association with kidney transplant survival and function. Methods: Retrospective cohort study analyzing post-kidney transplantation pregnancies (≥20 weeks gestation) from the Australia and New Zealand Dialysis and Transplant Registry (2000-2021). Graft survival was assessed in 3 models accounting for repeated pregnancies and episodes of pre-eclampsia. Results: Pre-eclampsia status was captured in 357/390 pregnancies and occurred in 133 pregnancies (37%). The percentage of pregnancies reported to have pre-eclampsia rose from 27% in 2000-2004, to 48% from 2018-2021. Reported prior exposure to calcineurin inhibitors was high overall, and higher in women who had pre-eclampsia (97% vs 88%, p=0.005). Seventy-two (27%) graft failures were identified after a pregnancy, with median follow-up of 8.08 years. Although women with pre-eclampsia had higher median preconception serum creatinine concentration (1.24 ((IQR) 1.00-1.50) vs. 1.13 (0.99-1.36) mg/dL; p=0.02), in all survival models, pre-eclampsia was not associated with higher death-censored graft failure. In multivariable analysis of maternal factors (age, body mass index, primary kidney disease and transplant-pregnancy interval, preconception serum creatinine concentration, era of birth event and Tacrolimus or Cyclosporin exposure) only era and preconception serum creatinine concentration ≥1.24 mg/dL (odds ratio 2.48, 95% CI 1.19-5.18) was associated with higher pre-eclampsia risk. Both preconception eGFR <45 ml/min/1.73m2 (adjusted HR 5.55, 95% CI 3.27-9.44, p<0.001) and preconception serum creatinine concentration ≥1.24 mg/dL (adjusted HR 3.06, 95% CI 1.77-5.27, p<0.001) were associated with a higher risk of graft failure even after adjusting for maternal characteristics. Conclusions: In this large and contemporaneous registry cohort, pre-eclampsia was not associated with worse graft survival or function. Preconception kidney function was the main determinant of graft survival.

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A nationwide Dutch cohort study shows relatively good pregnancy outcomes after kidney transplantation and finds risk factors for adverse outcomes

Cited by 19 publications

References 60 publications

Pregnancy outcomes after kidney transplantation: the challenges of success

Pregnancy outcomes after kidney transplantation: the challenges of success

Pregnancy after Kidney Transplantation—Impact of Functional Renal Reserve, Slope of eGFR before Pregnancy, and Intensity of Immunosuppression on Kidney Function and Maternal Health

Preeclampsia after Kidney Transplantation

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