A nationwide Dutch cohort study shows relatively good pregnancy outcomes after kidney transplantation and finds risk factors for adverse outcomes

• DOI: 10.1016/j.kint.2022.06.006
• Publication Date: 2022-06-28T06:01:16Z
• Authors: Margriet E. Gosse...; Marleen C. van Buren; Judith Kooiman; Henk Groen; Wessel Ganzevoort; Henk W. van Hamer...; Olivier W.H. van ...; Jacqueline van de...; A. Titia Lely
• Keywords: hypertension; pregnancy outcomes; Nephrology - Radboud University Medical Center; kidney transplantation; prepregnancy counseling; hemodynamic adaptation; Cohort Studies; 03 medical and health sciences; 0302 clinical medicine; Gynaecology - Radboud University Medical Center; Pre-Eclampsia; Pregnancy; Risk Factors; Birth Weight; Humans; Radboudumc 5: Inflammatory diseases RIMLS: Radboud Institute for Molecular Life Sciences; Renal Insufficiency, Chronic; Radboudumc 11: Renal disorders RIHS: Radboud Institute for Health Sciences; Infant, Newborn; Pregnancy Outcome; Infant; Kidney Transplantation; 3. Good health; Nephrology; Creatinine; Premature Birth; Female

Although numbers of pregnancy after kidney transplantation (KT) are rising, high risks adverse outcomes (APO) remain. Though important for pre-conception counselling and monitoring, analyses KT per pre-pregnancy estimated glomerular filtration rate-chronic disease (eGFR-CKD)-categories have not been performed on a large scale before. To do this, we conducted Dutch nationwide cohort study consecutive singleton pregnancies over 20 weeks gestation KT. Outcomes were analyzed eGFR-CKD category composite APO (cAPO) was established including birth weight under 2500 gram, preterm 37 weeks, third trimester severe hypertension (systolic blood pressure 160 and/or diastolic 110 mm Hg) 15% increase in serum creatinine during pregnancy. Risk factors cAPO multilevel model multiple imputation missing predictor values. In total, 288 192 women included. Total live 93%, mean gestational age 35.6 2383 gram. Independent risk eGFR, midterm percentage dip arterial dip; odds ratio 0.98 (95% confidence interval 0.96-0.99), 0.95 (0.93-0.98) 0.94 (0.90-0.98), respectively. The indicator graft loss (hazard 2.55, 1.09-5.96) but no significant factor its own when considering eGFR (2.18, 0.92-5.13). This the largest most comprehensive KT, with poor function, to facilitate individualized based function. Overall obstetric good. is mainly dependent function hemodynamic adaptation