TY - JOUR
T1 - A nationwide Dutch cohort study shows relatively good pregnancy outcomes after kidney transplantation and finds risk factors for adverse outcomes
AU - Gosselink, Margriet E
AU - van Buren, Marleen C
AU - Kooiman, Judith
AU - Groen, Henk
AU - Ganzevoort, Wessel
AU - van Hamersvelt, Henk W
AU - van der Heijden, Olivier W H
AU - van de Wetering, Jacqueline
AU - Lely, A Titia
N1 - Funding Information:
We are grateful to all members of the PARTOUT network and all students who participated in collection and assembly of data: M.F.C. de Jong, R. van der Molen, F.E. van Reekum, F.J. Bemelman, S.A. Nurmohammed, M. de Boer, J.H. Eijsink, A.P.J. de Vries, M. Sueters, W. Visser, M.H.L. Christiaans, M.E.A. Spaanderman, L. van Laar, N. Paauw, B. Reijtenbagh, A. Schaeffers, A. Schellekens, A. Slob, L. Koenjer, and J.R. Meinderts. Special thanks to J Rischen-Vos. This article was published as an abstract in Gosselink M, van Buren M, Groen H, et al. Midterm serum creatinine and blood pressure drop first trimester: prediction of adverse pregnancy outcomes in the Dutch renal transplant population. Transpl Int. 2019;32:188.
Publisher Copyright:
© 2022 International Society of Nephrology
PY - 2022/10
Y1 - 2022/10
N2 - Although numbers of pregnancy after kidney transplantation (KT) are rising, high risks of adverse pregnancy outcomes (APO) remain. Though important for pre-conception counselling and pregnancy monitoring, analyses of pregnancy outcomes after KT per pre-pregnancy estimated glomerular filtration rate-chronic kidney disease (eGFR-CKD)-categories have not been performed on a large scale before. To do this, we conducted a Dutch nationwide cohort study of consecutive singleton pregnancies over 20 weeks of gestation after KT. Outcomes were analyzed per pre-pregnancy eGFR-CKD category and a composite APO (cAPO) was established including birth weight under 2500 gram, preterm birth under 37 weeks, third trimester severe hypertension (systolic blood pressure over 160 and/or diastolic blood pressure over 110 mm Hg) and/or over 15% increase in serum creatinine during pregnancy. Risk factors for cAPO were analyzed in a multilevel model after multiple imputation of missing predictor values. In total, 288 pregnancies in 192 women were included. Total live birth was 93%, mean gestational age 35.6 weeks and mean birth weight 2383 gram. Independent risk factors for cAPO were pre-pregnancy eGFR, midterm percentage serum creatinine dip and midterm mean arterial pressure dip; odds ratio 0.98 (95% confidence interval 0.96-0.99), 0.95 (0.93-0.98) and 0.94 (0.90-0.98), respectively. The cAPO was a risk indicator for graft loss (hazard ratio 2.55, 1.09-5.96) but no significant risk factor on its own when considering pre-pregnancy eGFR (2.18, 0.92-5.13). This was the largest and most comprehensive study of pregnancy outcomes after KT, including pregnancies in women with poor kidney function, to facilitate individualized pre-pregnancy counselling based on pre-pregnancy graft function. Overall obstetric outcomes are good. The risk of adverse outcomes is mainly dependent on pre-pregnancy graft function and hemodynamic adaptation to pregnancy.
AB - Although numbers of pregnancy after kidney transplantation (KT) are rising, high risks of adverse pregnancy outcomes (APO) remain. Though important for pre-conception counselling and pregnancy monitoring, analyses of pregnancy outcomes after KT per pre-pregnancy estimated glomerular filtration rate-chronic kidney disease (eGFR-CKD)-categories have not been performed on a large scale before. To do this, we conducted a Dutch nationwide cohort study of consecutive singleton pregnancies over 20 weeks of gestation after KT. Outcomes were analyzed per pre-pregnancy eGFR-CKD category and a composite APO (cAPO) was established including birth weight under 2500 gram, preterm birth under 37 weeks, third trimester severe hypertension (systolic blood pressure over 160 and/or diastolic blood pressure over 110 mm Hg) and/or over 15% increase in serum creatinine during pregnancy. Risk factors for cAPO were analyzed in a multilevel model after multiple imputation of missing predictor values. In total, 288 pregnancies in 192 women were included. Total live birth was 93%, mean gestational age 35.6 weeks and mean birth weight 2383 gram. Independent risk factors for cAPO were pre-pregnancy eGFR, midterm percentage serum creatinine dip and midterm mean arterial pressure dip; odds ratio 0.98 (95% confidence interval 0.96-0.99), 0.95 (0.93-0.98) and 0.94 (0.90-0.98), respectively. The cAPO was a risk indicator for graft loss (hazard ratio 2.55, 1.09-5.96) but no significant risk factor on its own when considering pre-pregnancy eGFR (2.18, 0.92-5.13). This was the largest and most comprehensive study of pregnancy outcomes after KT, including pregnancies in women with poor kidney function, to facilitate individualized pre-pregnancy counselling based on pre-pregnancy graft function. Overall obstetric outcomes are good. The risk of adverse outcomes is mainly dependent on pre-pregnancy graft function and hemodynamic adaptation to pregnancy.
KW - hemodynamic adaptation
KW - hypertension
KW - kidney transplantation
KW - pregnancy outcomes
KW - prepregnancy counseling
UR - http://www.scopus.com/inward/record.url?scp=85135563316&partnerID=8YFLogxK
U2 - 10.1016/j.kint.2022.06.006
DO - 10.1016/j.kint.2022.06.006
M3 - Article
C2 - 35777440
SN - 0085-2538
VL - 102
SP - 866
EP - 875
JO - Kidney International
JF - Kidney International
IS - 4
ER -