Pregnancy outcomes after kidney transplantation: the challenges of success

Jesudason, Shilpanjali; Piccoli, Giorgina Barbara

doi:10.1016/j.kint.2022.08.007

Cited by 4 publications

(4 citation statements)

References 9 publications

(8 reference statements)

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“…Overall, we support Jesudason and Piccoli, who advocate for a large international dataset, which will have to incorporate comprehensive clinical data and monitoring modalities during pregnancy (taking into account the mother, allograft and fetal outcomes, as discussed), and relevant information regarding non-evolutive pregnancies (i.e., early miscarriages and terminations) ( 3 ). This might provide more evidence for preventive measures, the stratification of risk factors, management during pregnancy and follow-up, and counseling for parents ( 38 ).…”

Section: Discussionsupporting

confidence: 62%

See 1 more Smart Citation

Pregnancy after kidney transplantation: an observational study on maternal, graft and offspring outcomes in view of current literature

Stavart,

Verly,

Venetz

et al. 2023

Front. Nephrol.

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IntroductionPregnancy after kidney transplantation (KTx) is considered to have a high risk of non-negligible complications for the mother, the allograft, and the offspring. With an increased incidence of these pregnancies over the past decades, transplant nephrologists and specialized obstetricians face increasing challenges, with scarce literature regarding long-term outcomes.MethodsWe retrospectively collected data from all women with at least one live birth pregnancy after KTx who were followed at our tertiary hospital between 2000 and 2021 to study maternal, graft and fetal outcomes.ResultsTen patients underwent 14 live birth pregnancies after KTx. Preponderant maternal complications were stage 1 acute kidney injury (43%), urinary tract infections (UTI, 43%), progression of proteinuria without diagnostic criteria for preeclampsia (29%), and preeclampsia (14%). Median baseline serum creatinine at conception was 126.5 µmol/L [median estimated glomerular filtration rate (eGFR) 49 mL/min/1.73m2], and eGFR tended to be lower than baseline at follow-ups. Overall, there was no increase in preexisting or occurrence of de novo donor-specific antibodies. No graft loss was documented within the 2-year follow-up. There were nine premature births (64%), with a median gestational age of 35.7 weeks. The median birth weight, height, and head circumference were 2,560 g, 45.5 cm, and 32.1 cm, respectively. These measurements tended to improve over time, reaching a higher percentile than at birth, especially in terms of height, but on average remained under the 50th percentile curve.DiscussionOverall, pregnancies after KTx came with a range of risks for the mother, with a high prevalence of cesarean sections, emergency deliveries, UTI, and preeclampsia, and for the child, with a high proportion of prematurity, lower measurements at birth, and a tendency to stay under the 50th percentile in growth charts. The short- and long-term impact on the allograft seemed reassuring; however, there was a trend toward lower eGFR after pregnancy. With these data, we emphasize the need for a careful examination of individual risks via specialized pre-conception consultations and regular monitoring by a transplant nephrologist and a specialist in maternal–fetal medicine during pregnancy. More data about the long-term development of children are required to fully apprehend the impact of KTx on offspring.

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Section: Discussionsupporting

confidence: 62%

“…( 11 ). Whereas general guidelines recommend an eGFR > 60 mL/min/1.73 m 2 , we nevertheless support KTx women in their path to motherhood ( 3 , 12 ). We did not observe any graft loss during the 2-year follow-up, but two patients were relisted in that time frame due to progressive renal dysfunction following pregnancy.…”

Section: Discussioncontrasting

confidence: 59%

Pregnancy after kidney transplantation: an observational study on maternal, graft and offspring outcomes in view of current literature

Stavart,

Verly,

Venetz

et al. 2023

Front. Nephrol.

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“…Additionally, there were higher incidences of preterm delivery (43.1%-48.5%) and low birth weight babies (43.7%-56.3%). Furthermore, it was found that the stability and fluctuation of renal function in the year before pregnancy and renal hyperfiltration during pregnancy were significant risk factors for adverse events during pregnancy and the deterioration of renal function after delivery (6,(28)(29)(30). In this study, three of the four recipients delivered prematurely, with a mean gestation time of 35.1 weeks and a mean neonatal weight of 2,577 g. This small sample study suggested that pregnancy outcomes were essentially similar between post-kidney transplant couples and single post-kidney transplant mothers.…”

Section: Discussionmentioning

confidence: 99%

Successful pregnancies in post-kidney transplant couples: four case reports

et al. 2023

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BackgroundThe fertility of female kidney transplant recipients is increasing with the progression of transplant management. This article aims to evaluate the clinical prognosis of mothers and newborns for post-kidney transplant couples.MethodsFrom January 2019 to April 2022, a total of four couples, all kidney transplant recipients, were successfully prepared for pregnancy after a rigorous preconception evaluation, including three cases of natural conception and one case of in vitro fertilization. Data regarding the mother and newborn, including general clinical condition and laboratory results, were recorded and assessed throughout the pregnancy and up until 12 months after delivery.ResultsThe mean conception age of the mothers was 34.8 years (30–38 years), and the mean interval between renal transplantation and pregnancy was 6.6 years (3.7–8.7 years). All deliveries were by cesarean section and took place without incident. There were three premature births (<37 weeks; average 35.1 weeks). In case 1 (in vitro fertilization), pre-eclampsia occurred during maternity, and this was the only case in which the fetal weight was less than 2,500 g (average 2,576.7 g). The mean Apgar score (1 min) was 7.8 (6–9) and reached 9 in all cases at 5 min. The mothers’ eGFR rose during mid-gestation, decreased in late pregnancy, and was largely restored along with proteinuria 1 year postpartum. Postnatal evaluation at 6 months showed normal neurological development. In addition, NK cell and IFN-γ levels increased and Treg cell and IL-10 levels decreased along with the onset of pre-eclampsia.ConclusionsPregnancies can succeed in couples who are both kidney transplant recipients. However, there might be higher risks of infertility, prematurity, and low birth weight.

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“…Female recipients are particularly burdened when facing reproductive decisions. 23 Discussions focused on the need for family planning with a shift away from counseling against pregnancy toward supporting a well-informed choice. Access to reproductive care is critical.…”

Section: Key Issues and Future Directionsmentioning

confidence: 99%