Impact of Pregnancy on the Outcome of Kidney Transplantation

Kashanizadeh, N; Nemati, Eghlim; Sharifi-Bonab, Mirmohsen; Moghani-Lankarani, M.; Ghazizadeh, Shirin; Einollahi, Behzad; Lessan‐Pezeshki, Mahboob; Khedmat, Hossein

doi:10.1016/j.transproceed.2007.03.010

Cited by 30 publications

(33 citation statements)

References 11 publications

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“…Most evidence suggests that pregnancy after transplantation does not increase risk for loss of graft function, 15 so long as renal function is good (creatinine Ͻ1.5 mg/dl) and the patient is on a stable immunosuppressive regimen. In this situation, rejection rates are similar to the general transplant population, and there does not seem to be an increased risk for birth defects.…”

Section: Pregnancy After Kidney Transplantationmentioning

confidence: 99%

Pregnancy and the Kidney

Maynard¹,

Thadhani²

2009

Journal of the American Society of Nephrology

181

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In recognizing renal disease, measurement of kidney function and proteinuria are the early standard bearers of subclinical pathology. With the dramatic hormonal and hemodynamic changes of pregnancy, renal function is altered and these changes must be considered when assessing renal function in pregnancy and in the choice of medications provided through parturition. Renal function and filtration are also affected in preeclampsia, and recent advances have greatly expanded our understanding of the pathophysiologic mechanisms of this pregnancy-specific renal syndrome. ASSESSMENT OF GFR AND PROTEINURIA DURING PREGNANCY Estimating GFR in PregnancyThe physiologic increase in GFR during pregnancy normally results in a decrease in concentration of serum creatinine, which falls by an average of 0.4 mg/dl to a pregnancy range of 0.4 to 0.8 mg/dl. 1 Hence, a serum creatinine of 1.0 mg/dl, although normal in a nonpregnant individual, reflects renal impairment in a pregnant woman. The Modification of Diet in Renal Disease (MDRD) formula, which estimates GFR using a combination of serum markers and clinical parameters, has become a standard clinical method to estimate renal function in patients with chronic kidney disease (CKD). The use of this formula has not been well studied in the pregnant population, and guidelines on application of the MDRD formula specifically exclude interpretation in pregnant women. Creatinine-based formulas developed in nonpregnant populations are likely to be inaccurate when applied to pregnant women. For example, the fall in serum creatinine during pregnancy reflects not only the pregnancy-induced increase in real GFR but also hemodilution resulting from the 30 to 50% plasma volume expansion by parturition. Perhaps more important, the MDRD formula systematically underestimates GFR as GFR rises above 60 ml/min per m 2 . This inherent inaccuracy is likely to be more pronounced at the high GFR of pregnancy.Weight-based formulas, such as Cockroft-Gault, might overestimate GFR because the increased body weight of pregnancy does not typically reflect increased muscle mass or creatinine production.In 2007, the accuracy of the MDRD formula in pregnant women was formally evaluated for the first time in two prospective studies. 2,3 Smith et al. 2 compared the performance of the modified MDRD formula (based on age, serum creatinine, and gender) with inulin clearance in three groups of women: healthy pregnant volunteers, women with preeclampsia, and pregnant women with CKD before pregnancy. Among healthy pregnant women, creatinine clearance by 24-h urine collection closely approximated GFR by inulin clearance; however, the MDRD underestimated GFR by Ͼ40 ml/min, a degree of bias that is somewhat higher than observed in nonpregnant kidney transplant donors with normal renal function (29 ml/min). 4 Among pregnant women with preeclampsia or CKD, the MDRD formula performed slightly better, underestimating GFR by 23.3 and 27.3 ml/min, respectively; however, the average GFR of all three groups Published online ahead ...

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Section: Pregnancy After Kidney Transplantationmentioning

confidence: 99%

Pregnancy and the Kidney

Maynard¹,

Thadhani²

2009

Journal of the American Society of Nephrology

181

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“…Prenatal advice for women with a functioning kidney transplant has been primarily based on data derived from observational research, [1][2][3][4][5][6][7][8][9][10][11][12][13] and the reported live-birth rates achieved in such women range from 43.2 14 to 82%. 15 Although an increased pregnancy event number has been reported for women with a functioning kidney transplant, 16 little is actually known about "pregnancy rate changes" during the past 40 yr. More importantly, long-term graft and maternal survival analyses, referred to when advising women who have undergone transplantation and are considering a pregnancy, have been mostly performed without adequate matching, 12 or, alternatively, matching has been used but outcomes followed up for only brief intervals 14,17,18 and in small cohorts. 19 -22 Published graft matching studies to date suggest no adverse impact 10 yr after a live birth.…”

mentioning

confidence: 99%

“…14 In most instances, pregnancies in women with a kidney graft have been encouraged. Historically, renal function, 8,15,17,18 baseline proteinuria, 23 inter-current hypertension, 1,24 and time from transplantation 1,3,5,8,14,15,18,24,25 have been used to predict adverse event risks to the mother, kidney, and offspring. To this are added the often unquantifiable inherent risks for genetically transmitted diseases or the problems associated with prematurity.…”

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confidence: 99%

Pregnancy and Maternal Outcomes Among Kidney Transplant Recipients

Levidiotis

Chang²,

McDonald

2009

Journal of the American Society of Nephrology

131

100

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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.

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“…Investigators consistently showed that pregnancy after renal transplantation generally has excellent graft survival. In 5 studies, long-term outcomes were compared between patients with kidney transplantation and a history of pregnancy and those of nulliparous as the control and no significant differences were observed in the graft function or survival (10)(11)(12)(13)(14). The reported survival rates were 61.6% to 84.8% in patients with a history of pregnancy versus 58.1% to 78.8% in the controls at the 15 -year follow-up (10, 14).…”

Section: Discussionmentioning

confidence: 99%

“…Although graft dysfunction and obstructive uropathy are reported in pregnant patients with kidney transplantation (9), studies compared the long -term outcomes of pregnancy on transplanted kidney with nulliparous transplanted controls did not show significant differences in the function or survival of graft in long term (10)(11)(12)(13)(14)(15)(16)(17) (Table 1). Graft function in the 10 -year period was similar between patients with pregnancy history and controls (12)(13)(14)(15).…”

Section: The Effect Of Pregnancy On Transplanted Kidneymentioning

confidence: 98%

Currently Available Urine-Based Tumour Markers in the Detection of New and Recurrent Urothelial Bladder Cancer

Horstmann¹

2011

Nephro Urol Mon

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Context: The current study aimed at providing an evidence -based and up-to-date review of the literature regarding the assessment and outcomes of pregnancy in patients with renal transplant. Design: It was a review of the current literature. Conclusions: According to the current study findings, the function or survival of renal allograft was not adversely affected by getting pregnant. Therefore, ideal care for these patients needs a multidisciplinary approach including maternal-fetal medicine, nephrology, and neonatology specialists.

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Impact of Pregnancy on the Outcome of Kidney Transplantation

Cited by 30 publications

References 11 publications

Pregnancy and the Kidney

Pregnancy and the Kidney

Pregnancy and Maternal Outcomes Among Kidney Transplant Recipients

Currently Available Urine-Based Tumour Markers in the Detection of New and Recurrent Urothelial Bladder Cancer

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