Maternal and neonatal outcomes in kidney transplant recipients: a single-center observational study.
Kidney allograft functions
Maternal and newborn health
Preeclampsia
Pregnancy
Preterm birth
Journal
Wiener klinische Wochenschrift
ISSN: 1613-7671
Titre abrégé: Wien Klin Wochenschr
Pays: Austria
ID NLM: 21620870R
Informations de publication
Date de publication:
04 Sep 2024
04 Sep 2024
Historique:
received:
04
04
2024
accepted:
29
07
2024
medline:
5
9
2024
pubmed:
5
9
2024
entrez:
4
9
2024
Statut:
aheadofprint
Résumé
Pregnancy poses a high risk for adverse maternal and neonatal outcomes in kidney transplant recipients (KTRs), and data on long-term allograft functions compared to the healthy population are still limited. Therefore, we aimed to conduct a comparative analysis of maternal and neonatal outcomes in KTRs. In this retrospective single-center study, KTRs who experienced pregnancy after transplantation were evaluated in comparison with an age-matched non-transplanted control group. Maternal outcomes included obstetric complications (preeclampsia, peripartum hemorrhage, duration of maternal hospitalization) and a composite kidney outcome for KTRs defined as progression to graft failure necessitating dialysis or retransplantation or doubling of serum creatinine at the end of follow-up. Neonatal outcomes were gestational age, preterm birth, newborn mortality, admittance to the neonatal intensive care unit (NICU), Apgar scores, and birth weight. In 53 KTRs, 68 pregnancies occurred. Preeclampsia (p < 0.001) and preterm birth (p = 0.003) were significantly higher in KTRs. The KTR pregnancies had lower mean birth weights (p = 0.001) and longer durations of maternal hospitalization (p = 0.001). Neonatal mortality, NICU admissions, peripartum hemorrhage rates, and Apgar scores were similar between groups. Follow-up for a median of 105 months after the index birth showed higher serum creatinine levels at postpartum visits (p < 0.001) and at the last follow-up (p = 0.001) compared to baseline. Of the KTRs 6 (11.3%) experienced composite kidney outcomes, including 5 patients with graft failure and 1 with a doubling of serum creatinine. The KTRs exhibit comparable neonatal mortality and NICU admission rates but have higher rates of preeclampsia and preterm birth. Importantly, graft functions worsen significantly during postpartum follow-up.
Identifiants
pubmed: 39231814
doi: 10.1007/s00508-024-02425-2
pii: 10.1007/s00508-024-02425-2
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Austria, part of Springer Nature.
Références
Dumanski SM, Ahmed SB. Fertility and reproductive care in chronic kidney disease. J Nephrol. 2019;32(1):39–50.
doi: 10.1007/s40620-018-00569-9
pubmed: 30604149
Deshpande NA, James NT, Kucirka LM, Boyarsky BJ, Garonzik-Wang JM, Montgomery RA, et al. Pregnancy outcomes in kidney transplant recipients: a systematic review and meta-analysis. Am J Transplant. 2011;11(11):2388–404.
doi: 10.1111/j.1600-6143.2011.03656.x
pubmed: 21794084
Murray JE, Merrill JP, Harrison JH. Kidney transplantation between seven pairs of identical twins. Ann Surg. 1958;148(3):343–59.
doi: 10.1097/00000658-195809000-00004
pubmed: 13571912
pmcid: 1450810
Sibanda N, Briggs JD, Davison JM, Johnson RJ, Rudge CJ. Pregnancy after organ transplantation: a report from the UK transplant pregnancy registry. Transplantation. 2007;83(10):1301–7.
doi: 10.1097/01.tp.0000263357.44975.d0
pubmed: 17519778
Wyld ML, Clayton PA, Jesudason S, Chadban SJ, Alexander SI. Pregnancy outcomes for kidney transplant recipients. Am J Transplant. 2013;13(12):3173–82.
doi: 10.1111/ajt.12452
pubmed: 24266970
Shah S, Venkatesan RL, Gupta A, Sanghavi MK, Welge J, Johansen R, et al. Pregnancy outcomes in women with kidney transplant: Metaanalysis and systematic review. BMC Nephrol. 2019;20(1):24.
doi: 10.1186/s12882-019-1213-5
pubmed: 30674290
pmcid: 6345071
Gosselink ME, van Buren MC, Kooiman J, Groen H, Ganzevoort W, van Hamersvelt HW, et al. A nationwide Dutch cohort study shows relatively good pregnancy outcomes after kidney transplantation and finds risk factors for adverse outcomes. Kidney Int. 2022;102(4):866–75.
doi: 10.1016/j.kint.2022.06.006
pubmed: 35777440
McKay DB, Josephson MA, Armenti VT, August P, Coscia LA, Davis CL, et al. Reproduction and transplantation: report on the AST consensus conference on reproductive issues and transplantation. Am J Transplant. 2005;5(7):1592–9.
doi: 10.1111/j.1600-6143.2005.00969.x
pubmed: 15943616
Stoumpos S, McNeill SH, Gorrie M, Mark PB, Brennand JE, Geddes CC, et al. Obstetric and long-term kidney outcomes in renal transplant recipients: a 40-yr single-center study. Clin Transplant. 2016;30(6):673–81.
doi: 10.1111/ctr.12732
pubmed: 26992458
Levidiotis V, Chang S, McDonald S. Pregnancy and maternal outcomes among kidney transplant recipients. J Am Soc Nephrol. 2009;20(11):2433–40.
doi: 10.1681/ASN.2008121241
pubmed: 19797167
pmcid: 2799176
Gorgulu N, Yelken B, Caliskan Y, Turkmen A, Sever MS. Does pregnancy increase graft loss in female renal allograft recipients? Clin Exp Nephrol. 2010;14(3):244–7.
doi: 10.1007/s10157-009-0263-6
pubmed: 20091332
Hou S. Pregnancy in chronic renal insufficiency and end-stage renal disease. Am J Kidney Dis. 1999;33(2):235–52.
doi: 10.1016/S0272-6386(99)70296-9
pubmed: 10023634
Schwarz A, Schmitt R, Einecke G, Keller F, Bode U, Haller H, et al. Graft function and pregnancy outcomes after kidney transplantation. BMC Nephrol. 2022;23(1):27.
doi: 10.1186/s12882-022-02665-2
pubmed: 35022021
pmcid: 8753888
Levey AS, Stevens LA, Schmid CH, Zhang YL, Castro AF 3rd, Feldman HI, et al. A new equation to estimate glomerular filtration rate. Ann Intern Med. 2009;150(9):604–12.
doi: 10.7326/0003-4819-150-9-200905050-00006
pubmed: 19414839
pmcid: 2763564
-. WHO: recommended definitions, terminology and format for statistical tables related to the perinatal period and use of a new certificate for cause of perinatal deaths. Modifications recommended by FIGO as amended october 14, 1976. Acta Obstet Gynecol Scand. 1977;56(3):247–53.
pubmed: 560099
Phipps EA, Thadhani R, Benzing T, Karumanchi SA. Pre-eclampsia: pathogenesis, novel diagnostics and therapies. Nat Rev Nephrol. 2019;15(5):275–89.
doi: 10.1038/s41581-019-0119-6
pubmed: 30792480
pmcid: 6472952
Armenti VT, Radomski JS, Moritz MJ, Gaughan WJ, Philips LZ, McGrory CH, et al. Report from the national transplantation pregnancy registry (NTPR): outcomes of pregnancy after transplantation. Clin Transpl. 2002; 121–30.
Gill JS, Zalunardo N, Rose C, Tonelli M. The pregnancy rate and live birth rate in kidney transplant recipients. Am J Transplant. 2009;9(7):1541–9.
doi: 10.1111/j.1600-6143.2009.02662.x
pubmed: 19459800
Control CfD, Prevention, Statistics NCfH, System NVS. National vital statistics reports: US Department of Health & Human Services, Centers for Disease Control and …; 2012.
Ulgu MM, Birinci S, Altun Ensari T, Gözükara MG. Cesarean section rates in Turkey 2018–2023: overview of national data by using robson ten group classification system. Turk J Obstet Gynecol. 2023;20(3):191–8.
doi: 10.4274/tjod.galenos.2023.68235
pubmed: 37667479
pmcid: 10478731
Hortu I, Arı SA, Akdemir A, Koroglu OA, Yılmaz M, Toz H, et al. Perinatal outcomes of renal transplant pregnancies: a 22-year experience at a single tertiary referral center. J Matern Fetal Neonatal Med. 2020;33(17):3028–34.
doi: 10.1080/14767058.2019.1639664
pubmed: 31288677
Han J, McCormick CA, Krelle A, Champion de Crespigny P, Unterscheider J. Pregnancy outcomes post-kidney transplantation across 23 years. Aust N Z J Obstet Gynaecol. 2024;.
Kim HW, Seok HJ, Kim TH, Han DJ, Yang WS, Park SK. The experience of pregnancy after renal transplantation: pregnancies even within postoperative 1 year may be tolerable. Transplantation. 2008;85(10):1412–9.
doi: 10.1097/TP.0b013e318170f8ed
pubmed: 18497680
Bramham K, Nelson-Piercy C, Gao H, Pierce M, Bush N, Spark P, et al. Pregnancy in renal transplant recipients: a UK national cohort study. Clin J Am Soc Nephrol. 2013;8(2):290–8.
doi: 10.2215/CJN.06170612
pubmed: 23085724
Mohammadi FA, Borg M, Gulyani A, McDonald SP, Jesudason S. Pregnancy outcomes and impact of pregnancy on graft function in women after kidney transplantation. Clin Transplant. 2017;31(10).
van Buren MC, Schellekens A, Groenhof TKJ, van Reekum F, van de Wetering J, Paauw ND, et al. Long-term graft survival and graft function following pregnancy in kidney transplant recipients: a systematic review and meta-analysis. Transplantation. 2020;104(8):1675–85.
doi: 10.1097/TP.0000000000003026
pubmed: 32732847
Piccoli GB, Cabiddu G, Attini R, Gerbino M, Todeschini P, Perrino ML, et al. Outcomes of pregnancies after kidney transplantation: lessons learned from CKD. A comparison of transplanted, Nontransplanted chronic kidney disease patients and low-risk pregnancies: a multicenter nationwide analysis. Transplantation. 2017;101(10):2536–44.
doi: 10.1097/TP.0000000000001645
pubmed: 28114169
Kattah AG, Albadri S, Alexander MP, Smith B, Parashuram S, Mai ML, et al. Impact of pregnancy on GFR decline and kidney histology in kidney transplant recipients. Kidney Int Rep. 2022;7(1):28–35.
doi: 10.1016/j.ekir.2021.10.010
pubmed: 35005311
First MR, Combs CA, Weiskittel P, Miodovnik M. Lack of effect of pregnancy on renal allograft survival or function. Transplantation. 1995;59(4):472–6.
doi: 10.1097/00007890-199502270-00004
pubmed: 7878748
Park S, Lee SM, Park JS, Hong JS, Chin HJ, Na KY, et al. Midterm eGFR and adverse pregnancy outcomes: the clinical significance of gestational hyperfiltration. Clin J Am Soc Nephrol. 2017;12(7):1048–56.
doi: 10.2215/CJN.12101116
pubmed: 28611078
pmcid: 5498359
Hariharan S, Israni AK, Danovitch G. Long-term survival after kidney transplantation. N Engl J Med. 2021;385(8):729–43.
doi: 10.1056/NEJMra2014530
pubmed: 34407344
El Ters M, Grande JP, Keddis MT, Rodrigo E, Chopra B, Dean PG, et al. Kidney allograft survival after acute rejection, the value of follow-up biopsies. Am J Transplant. 2013;13(9):2334–41.
doi: 10.1111/ajt.12370
pubmed: 23865852
Loupy A, Haas M, Roufosse C, Naesens M, Adam B, Afrouzian M, et al. The Banff 2019 kidney meeting report (I): updates on and clarification of criteria for T cell- and antibody-mediated rejection. Am J Transplant. 2020;20(9):2318–31.
doi: 10.1111/ajt.15898
pubmed: 32463180
pmcid: 7496245
Attini R, Cabiddu G, Ciabatti F, Montersino B, Carosso AR, Gernone G, et al. Chronic kidney disease, female infertility, and medically assisted reproduction: a best practice position statement by the kidney and pregnancy group of the Italian society of nephrology. J Nephrol. 2023;36(5):1239–55.
doi: 10.1007/s40620-023-01670-4
pubmed: 37354277
pmcid: 11081994
Szypulska-Koziarska D, Misiakiewicz-Has K, Wiszniewska B. Hormonal (Im)balance and reproductive system’s disorders in transplant recipients—a review. Biol. 2021;10(4).
Nouri K, Bader Y, Helmy S, Ott J, Jirecek S, Tempfer CB. Live birth after in vitro fertilization and single embryo transfer in a kidney transplant patient: a case report and review of the literature. J Assist Reprod Genet. 2011;28(4):351–3.
doi: 10.1007/s10815-010-9521-5
pubmed: 21161364