Preeclampsia in kidney transplanted women; Outcomes and a simple prognostic risk score system

Abstract

Women pregnant following kidney transplantation are at high risk of preeclampsia. Identifying the effects of preeclampsia on pregnancy outcome and allograft function in kidney transplanted women, and predicting which women will require more targeted follow-up and possible therapeutic intervention, could improve both maternal and neonatal outcome. In this retrospective cohort study of all pregnancies following kidney transplantation in Norway between 1969 and 2013, we used medical records to identify clinical characteristics predictive of preeclampsia. 175 pregnancies were included, in which preeclampsia was diagnosed in 65. Pregnancies with preeclampsia had significantly higher postpartum serum creatinine levels, higher risks of preterm delivery, caesarean delivery, and small for gestational age infants. In the final multivariate model chronic hypertension (aOR = 5.02 [95% CI, 2.47–10.18]), previous preeclampsia (aOR = 3.26 [95% CI, 1.43–7.43]), and elevated serum creatinine (≥125 μmol/L) at the start of pregnancy (aOR = 5.79 [95% CI, 1.91–17.59]) were prognostic factors for preeclampsia. Based on this model the risk was 19% when none of these factors were present, 45–59% risk when one was present, 80–87% risk when two were present, and 96% risk when all three were present. We suggest that the risk of preeclampsia in pregnancies in kidney transplanted women can be predicted with these variables, which are easily available at the start of pregnancy.

Pregnancy outcomes in women with kidney transplant: Metaanalysis and systematic review

“…While prior studies have not reported higher rates of neonatal mortality and stillbirths in kidney transplant recipients, the current study finding is highly significant. Possible reasons could be prematurity, preeclampsia or presence of other risk factors like hypertension, proteinuria, and serum creatinine of 1.5 mg/dl or higher [26–28]. While it was not possible to determine the exact cause for stillbirth or neonatal mortality, this study finding is critical for counselling of women of child bearing age contemplating pregnancy.…”

Two pregnancies after simultaneous pancreas–kidney transplantation: A case report

“…However, for the second pregnancy, pre-eclampsia in a previous pregnancy was recognised to be a strong predictor of likely recurrence in transplanted women. 20 In conclusion, SPKT with stable pre-pregnancy graft function enabled this patient to achieve successful pregnancy. The risks of SPKT pregnancies appear similar to those in KT recipients; graft stability remains essential to minimizing these risks.…”

“…In our patient, the development of new hypertension and kidney graft dysfunction suggested super-imposed pre-eclampsia, prompting delivery in both pregnancies. Our patient had a preconception serum creatinine (<110 umol/L) that placed her at lower risk for adverse pregnancy outcome according to studies where serum creatinine was used to risk-stratify transplant pregnancies, [17][18][19][20] and also did not have chronic hypertension. However, for the second pregnancy, pre-eclampsia in a previous pregnancy was recognised to be a strong predictor of likely recurrence in transplanted women.…”

Long noncoding RNA SNHG12 promotes the proliferation, migration, and invasion of trophoblast cells by regulating the epithelial–mesenchymal transition and cell cycle

“…PE is the main reason for infant death, fetal body dysplasia, and damage of different maternal organs. [16][17][18] In a general sense, the development of PE is associated with pregnancy-induced hypertension and renal failure. 19 Therefore, it is important to clarify the specific molecular mechanism underlying the occurrence of PE and identify the molecules that regulate the development of PE.…”