A multi-institutional study of renal outcomes and renal-related pregnancy outcomes in uterus transplant recipients.
kidney function
pre-eclampsia
uterus transplant
Journal
American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons
ISSN: 1600-6143
Titre abrégé: Am J Transplant
Pays: United States
ID NLM: 100968638
Informations de publication
Date de publication:
12 2022
12 2022
Historique:
revised:
16
06
2022
received:
03
04
2022
accepted:
03
07
2022
pubmed:
14
7
2022
medline:
6
12
2022
entrez:
13
7
2022
Statut:
ppublish
Résumé
Uterus transplantation (UTx) is an effective treatment option for uterine factor infertility. However, the need for immunosuppression and congenital renal anomalies that coexist with uterine agenesis in about 30% of women with Mayer-Rokitansky-Kuster-Hauser syndrome create a risk for renal dysfunction. We therefore examined renal function trajectory and related pregnancy complications in an international cohort of 18 UTx recipients from September 2016-February 2020 who had at least one live birth. All UTx recipients had a diminution in their renal function that was apparent starting at 30 days posttransplant and in half the reduction in eGFR was at least 20%; the decrease in eGFR persisted into the early post-partum period. Half met criteria for Stage 1 acute kidney injury (AKI) as defined by the AKI Network criteria during their pregnancy. Overall, 28% of UTx recipients developed pre-eclampsia. eGFR was lower at embryo transfer and throughout pregnancy among those who developed pre-eclampsia, reaching statistical significance at week 16 of pregnancy. This effect was independent of tacrolimus levels. Mean eGFR remained significantly lower in the first 1-3 months after delivery. In the subgroup who reached 12 months of postpartum follow up and had a graft hysterectomy (n = 4), there was no longer a statistical difference in eGFR (pretransplant 106.7 ml/m ± 17.7 vs. 12 mos postpartum 92.6 ml/m ± 21.7, p = .13) but the number was small. Further study is required to delineate long term renal risks for UTx recipients, improve patient selection, and make decisions regarding a second pregnancy.
Identifiants
pubmed: 35822437
doi: 10.1111/ajt.17149
pii: S1600-6135(23)00062-X
doi:
Types de publication
Multicenter Study
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
3101-3110Informations de copyright
© 2022 The American Society of Transplantation and the American Society of Transplant Surgeons.
Références
Brännström M, Johannesson L, Bokström H, et al. Livebirth after uterus transplantation. Lancet. 2015;385:607-616.
Johannesson L, Testa G, Putman JM, McKenna GJ, Koon EC, York JR, Bayer J, Zhang L, Rubeo ZS, Gunby RT, Gregg AR Twelve live births after uterus transplantation in the Dallas UtErus transplant study. Obstet Gynecol 2021 1:137(2):241, 249.
Vali S, Jones BP, Saso S, Yazbek J, Quiroga I, Smith JR. Uterus transplantation: a 50-year journey. Clin Obstet Gynecol. 2022;65(1):92-100.
Jones BP, Kasaven L, Vali S, et al. Uterine transplantation: review of livebirths and reproductive implications. Transplantation. 2021;105(8):1695-1707.
Perni UC, Wang EY, Gregg AR. Antepartum care of the uterus transplant patient: the experience of 3 successful US centers. Clin Obstet Gynecol. 2022;65(1):84-91.
Chen N, Pan H, Luo G, et al. Clinical characteristics of 1,055 Chinese patients with Mayer-Rokitansky-Kuster-Hauser syndrome: a nationwide multicentric study. Fertil Steril. 2021;116(2):558-565.
Argueso LR, Ritchey ML, Boyle ET Jr, Milliner DS, Bergstralh EJ, Kramer SA. Prognosis of patients with unilateral renal agenesis. Pediatr Nephrol. 1992;6:412-416.
Shapiro E, Goldfarb DA, Ritchey ML. The congenital and acquired solitary kidney. Rev Urol. 2003;5(1):2-8.
Wiles K, Chappell LC, Lightstone L, Bramham K. Updates in diagnosis and management of preeclampsia in women with CKD. CJASN. 2020;15:1371-1380.
Garg AX, Nevis IF, McArthur E, et al. Gestational hypertension and preeclampsia in living kidney donors. N Engl J Med. 2015;372:124-133.
Kristensen JH, Basit S, Wohlfahrt J, Damholt MB, Boyd HA. Preeclampsia and risk of later kidney disease: Nationwide cohort study. BMJ. 2019;365:l1516.
Wiles K, Chappell L, Clark K, et al. Clinical practice guideline on pregnancy and renal disease. BMC Nephrol. 2019;20:401.
Coscia LA, Constantinescu S, Mortiz MJ, et al. Report from the National Transplantation Pregnancy Registry (NTPR): outcomes of pregnancy after transplantation. Clin Transpl. 2010;65-85.
Shah S, Venkatesan RL, Gupta A, et al. Pregnancy outcomes in women with kidney transplant: metaanalysis and systematic review. BMC Nephrol. 2019;20:24.
Feng Z, Minard C, Raghavan R. Pregnancy outcomes in advanced kidney disease. Clin Nephrol. 2015;83:272-278.
Kendrick J, Sharma S, Holmen J, Palit S, Nuccio E, Chonchol M. Kidney disease and maternal and fetal outcomes in pregnancy. AJKD. 2015;66(1):55-59.
Johannesson L, Wall A. Uterus transplantation - donor and recipient work up. Curr Opin Organ Transplant. 2021;26:634-639.
Testa G, McKenna GJ, Bayer J, et al. The evolution of transplantation from saving lives to fertility treatment: DUETS (Dallas UtErus transplant study). Ann Surg. 2020;272(3):411-417.
York JR, Testa G, Gunby RT, et al. Neonatal outcomes after uterus transplantation: Dallas uterus transplant study. Am J Perinatol. 2021. doi:10.1055/s-0041-1727212. Online ahead of print.
Fronek J, Kristek J, Chlupac J, Janousek L, Olausson M. Human uterus transplantation from living and deceased donors: the interim results of the first 10 cases of the Czech trial. J Clin Med. 2021;10(4):586.
Inker LA, Eneanya ND, Coresh J, et al. New creatinine and cystatin C based equations to estimate GFR without race. N Engl J Med. 2021;385:1737-1749.
Harel Z, McArthur E, Hladunewich M, et al. Serum creatinine levels before, during, and after pregnancy. JAMA. 2019;321(2):205-207.
Mehta RL, Kellum JA, Shah SV, et al. Acute kidney injury network: report of an initiative to improve outcomes in acute kidney injury. Crit Care. 2007;11:R31.
Mehrabadi A, Dahhou M, Joseph KS, Kramer M.S. Investigation of a rise in obstetric acute renal failure in the United States, 1999-2011. Obstet Gynecol 2016 127:899-906
Szczepanski J, Griffin A, Novotny S, Wallace K. Acute kidney injury in pregnancies complicated with preeclampsia or HELLP syndrome. Front Med. 2020;7:22.
Michalska M, Wen K, Pauly RP. Acute kidney injury in pregnant patient with pancreas-kidney transplant caused by abdominal compartment syndrome: a case presentation, review of literature and proposal of diagnostic approach. Can J Kidney Health Dis. 2019;6:2054358119861942.
Vikse BE, Irgens LM, Leivestad T, Skjaerven R, Iversen BM. Preeclampsia and the risk of end-stage renal disease. N Engl J Med. 2008;359:800-809.
Klein CL, Josephson MA. Post-transplant pregnancy and contraception. CJASN. 2022;17:114-120.
Zhang JJ, Ma XX, Hao L, Liu LJ, Lv JC, Zhang H. A systematic review and meta-analysis of outcomes of pregnancy in CKD and CKD outcomes in pregnancy. Clin J Am Soc Nephrol. 2015;10:1964-1978.
Cheung KL, Lafayette RA. Renal physiology of pregnancy. Adv Chronic Kidney Dis. 2013;20(3):209-214.
Shapiro J, Ray JG, McArthur E, et al. Risk of acute kidney injury after hypertensive disorders of pregnancy: a population-based cohort study. Am J Kidney Dis. 2021;79:561-569.