Abstract
Objectives
Maternal and fetal complications can occur in pregnant kidney transplant recipients. Since these are high-risk pregnancies, they require a multidisciplinary follow-up to prematurely detect adverse events. Identifying factors that would affect fetal, maternal and graft outcomes is essential to further stratify the risk of pregnant kidney transplant recipients.
Methods
All pregnancies in kidney transplant recipients followed in a single center for 30 years were included. Data included previous transplant information and blood and urine tests performed before pregnancy. Impact of graft function on fetal, maternal and graft outcomes was evaluated.
Results
There were 41 pregnancies among 34 patients. Mean gestational age of 35 ± 3 weeks. Caesarean section was performed in 69.4% of patients. Five pregnancies were unsuccessful (12.2%). Four patients suffered an acute graft dysfunction (9.8%) and 12 (29.3%) had a serious maternal hypertensive disorder (preeclampsia, eclampsia or HELLP syndrome). Graft function before pregnancy showed significant correlation with adverse outcomes.
Conclusions
A proteinuria >669 mg/g, serum creatinine >1.75 mg/dL and glomerular filtration rate <36.2 mL/min/1.73 m2 before pregnancy were correlated to graft dysfunction during pregnancy. Similar values of proteinuria were also associated with a risk of maternal hypertensive disorders and pregnancy failure. Therefore, in patients with proteinuria and graft dysfunction, follow-up should be stricter to quickly detect complications.
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Research funding: None declared.
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Author contributions: FSM – Contributed in the analysis and interpretation of data as well as drafting, revising the article and provided critical intellectual input. JO – Contributed in the analysis and interpretation of data as well as drafting and revising the article. FS – Contributed in drafting and revising the article. DA – Contributed by providing critical intellectual input revising the article. ACF – Contributed in the analysis and interpretation of data. AB – Contributed by providing critical intellectual input revising the article. MSJP – Contributed by providing critical intellectual input revising the article. AG – Contributed in the analysis of data as well as drafting, revising the article and provided critical intellectual input. PM – Contributed in drafting and revising the article. RA – Contributed in the analysis of data as well as drafting, revising the article and provided critical intellectual input. All authors have accepted responsibility for the entire content of this manuscript and approved its submission.
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Competing interest: Authors state no conflict of interest.
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Informed consent: Not applicable.
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Ethical approval: This research was conducted according to the Declaration of Helsinki and the Declaration of Istanbul ensuring that the anonymity of all patients was guaranteed.
References
1. Lin, CT, Liu, XN, Xu, HL, Sui, HY. Menstrual disturbances in premenopausal women with end-stage renal disease: a cross-sectional study. Med Princ Pract 2016;25:260–5. https://doi.org/10.1159/000444879.Search in Google Scholar PubMed PubMed Central
2. Matuszkiewicz-Rowinska, J, Skorzewska, K, Radowicki, S, Niemczyk, S, Sokalski, A, Przedlacki, J, et al.. Endometrial morphology and pituitary-gonadal axis dysfunction in women of reproductive age undergoing chronic haemodialysis – a multicentre study. Nephrol Dial Transplant 2004;19:2074–7. https://doi.org/10.1093/ndt/gfh279.Search in Google Scholar PubMed
3. Öyekçin, DG, Gülpek, D, Sahin, EM, Mete, L. Depression, anxiety, body image, sexual functioning, and dyadic adjustment associated with dialysis type in chronic renal failure. Int J Psychiatr Med 2012;43:227–41. https://doi.org/10.2190/pm.43.3.c.Search in Google Scholar PubMed
4. Shah, S, Verma, P. Overview of pregnancy in renal transplant patients. Int J Nephrol 2016;2016:4539342. https://doi.org/10.1155/2016/4539342.Search in Google Scholar PubMed PubMed Central
5. Wang, GC, Zheng, JH, Xu, LG, Min, ZL, Zhu, YH, Qi, J, et al.. Measurements of serum pituitary-gonadal hormones and investigation of sexual and reproductive functions in kidney transplant recipients. Internet J Nephrol 2010;2010:1–6. https://doi.org/10.4061/2010/612126.Search in Google Scholar PubMed PubMed Central
6. Pertuz, W, Castaneda, DA, Rincon, O, Lozano, E. Sexual dysfunction in patients with chronic renal disease: does it improve with renal transplantation? Transplant Proc 2014;46:3021–6. https://doi.org/10.1016/j.transproceed.2014.07.017.Search in Google Scholar PubMed
7. Patrícia, C. The challenge of pregnancy after kidney transplantation. Portuguese J Nephrol Hypertens 2018;32:143–8.Search in Google Scholar
8. 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;8:290–8. https://doi.org/10.2215/cjn.06170612.Search in Google Scholar
9. Rahamimov, R, Ben-Haroush, A, Wittenberg, C, Mor, E, Lustig, S, Gafter, U, et al.. Pregnancy in renal transplant recipients: long-term effect on patient and graft survival. A single-center experience. Transplantation 2006;81:660–4. https://doi.org/10.1097/01.tp.0000166912.60006.3d.Search in Google Scholar PubMed
10. Kidney Disease: Improving Global Outcomes (KDIGO) Transplant Work Group. KDIGO clinical practice guidelines for the care of kidney transplant recipients. Am J Transplant 2009;9(3 Suppl):S106–9.10.1111/j.1600-6143.2009.02834.xSearch in Google Scholar PubMed
11. Imbasciati, E, Gregorini, G, Cabiddu, G, Gammaro, L, Ambroso, G, Del Giudice, A, et al.. Pregnancy in CKD stages 3 to 5: fetal and maternal outcomes. Am J Kidney Dis 2007;49:753–62. https://doi.org/10.1053/j.ajkd.2007.03.022.Search in Google Scholar PubMed
12. Salvador, CL, Hartmann, A, Åsberg, A, Bergan, S, Rowe, AD, Mørkrid, L. Estimating glomerular filtration rate in kidney transplant recipients: comparing a novel equation with commonly used equations in this population. Transplant Direct 2017;3:e332. https://doi.org/10.1097/txd.0000000000000742.Search in Google Scholar PubMed PubMed Central
13. Brown, MA, Magee, LA, Kenny, LC, Karumanchi, SA, McCarthy, FP, Saito, S, et al.. Hypertensive disorders of pregnancy: ISSHP classification, diagnosis, and management recommendations for international practice. Hypertension (Dallas) 2018;72:24–43. https://doi.org/10.1161/hypertensionaha.117.10803.Search in Google Scholar PubMed
14. International Association of Diabetes and Pregnancy Study Groups Consensus Panel, Metzger, BE, Gabbe, SG, Persson, B, Buchanan, TA, Catalano, PA, et al.. International association of diabetes and pregnancy study groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy. Diabetes Care 2010;33:676–82. https://doi.org/10.2337/dc09-1848.Search in Google Scholar PubMed PubMed Central
15. American College of Obstetricians and Gynecologists’ Committee on Practice Bulletins—Obstetrics and the Society for Maternal-Fetal Medicine. ACOG practice bulletin no. 204: fetal growth restriction. Obstet Gynecol 2019;133:e97–109. https://doi.org/10.1097/AOG.0000000000003070.Search in Google Scholar PubMed
16. Kiserud, T, Piaggio, G, Carroli, G, Widmer, M, Carvalho, J, Jensen, LN, et al.. The World Health Organization fetal growth charts: a multinational longitudinal study of ultrasound biometric measurements and estimated fetal weight [published correction appears in PLoS Med. 2017 Mar 24;14 (3):e1002284] [published correction appears in PLoS Med. 2017 Apr 20;14 (4):e1002301] [published correction appears in PLoS Med. 2021 Jan 7;18(1):e1003526]. PLoS Med 2017;14:e1002220. https://doi.org/10.1371/journal.pmed.1002220.Search in Google Scholar PubMed PubMed Central
17. 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;20:24. https://doi.org/10.1186/s12882-019-1213-5.Search in Google Scholar PubMed PubMed Central
18. Coscia, LA, Constantinescu, S, Moritz, MJ, Frank, AM, Ramirez, CB, Maley, WR, et al.. Report from the national transplantation pregnancy registry (NTPR): outcomes of pregnancy after transplantation. Clin Transplant 2010;65–85.Search in Google Scholar
19. 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;11:2388–404. https://doi.org/10.1111/j.1600-6143.2011.03656.x.Search in Google Scholar PubMed
20. Mariano, S, Guida, JPS, Sousa, MV, Parpinelli, MA, Surita, FG, Mazzali, M, et al.. Pregnancy among women with kidney transplantation: a 20-years single-center registry. Rev Bras Ginecol Obstet 2019;41:419–24. https://doi.org/10.1055/s-0039-1688834.Search in Google Scholar PubMed
21. Bachmann, F, Budde, K, Gerland, M, Wiechers, C, Heyne, N, Nadalin, S, et al.. Pregnancy following kidney transplantation – impact on mother and graft function and focus on childrens’ longitudinal development. BMC Pregnancy Childbirth 2019;19:376. https://doi.org/10.1186/s12884-019-2496-z.Search in Google Scholar PubMed PubMed Central
22. McKay, DB, Josephson, MA. Pregnancy after kidney transplantation. Clin J Am Soc Nephrol 2008;3(2 Suppl):S117–25. https://doi.org/10.2215/CJN.02980707.Search in Google Scholar PubMed PubMed Central
23. Roberge, S, Nicolaides, KH, Demers, S, Villa, P, Bujold, E. Prevention of perinatal death and adverse perinatal outcome using low-dose aspirin: a meta-analysis. Ultrasound Obstet Gynecol 2013;41:491–9. https://doi.org/10.1002/uog.12421.Search in Google Scholar PubMed
24. Majak, GB, Reisæter, AV, Zucknick, M, Lorentzen, B, Vangen, S, Henriksen, T, et al.. Preeclampsia in kidney transplanted women; outcomes and a simple prognostic risk score system. PLoS One 2017;12:e0173420. https://doi.org/10.1371/journal.pone.0173420.Search in Google Scholar PubMed PubMed Central
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