Kidney Week

Abstract: SA-OR110

Effects of Pregnancy on Kidney Allograft Outcomes

Session Information

• Women's Health and Kidney Diseases
  November 09, 2019 | Location: 145, Walter E. Washington Convention Center
  Abstract Time: 04:54 PM - 05:06 PM

Category: Women’s Health and Kidney Diseases

• 2000 Women’s Health and Kidney Diseases

Authors

• Kattah, Andrea G., Mayo Clinic, Rochester, Minnesota, United States

Andrea G. Kattah, MD, MS



Andrea Kattah is an Assistant Professor of Medicine in the Division of Nephrology and Hypertension at Mayo Clinic in Rochester. She completed medical school at NYU and an internal medicine residency at Columbia University. She came to Mayo Clinic in Rochester in 2011 and completed a nephrology fellowship in 2014, followed by a Women’s Health fellowship. She completed her Masters in Clinical and Translational Science at Mayo Graduate School in 2016. Her clinical and research interests include how pregnancy and menopause impact kidney health in women.

• Cosio, Fernando G., Mayo Clinic, Rochester, Minnesota, United States

Fernando G. Cosio,

• Garovic, Vesna D., Mayo Clinic, Rochester, Minnesota, United States

Vesna D. Garovic,

Background

Women with chronic kidney disease are often counseled to wait until after a successful kidney transplant (TX) to pursue pregnancy. However, pregnancy after kidney TX is still high risk and the effects on graft function and long-term graft survival are unclear.

Methods

We identified all kidney TXs in women ages 18 to 44 at all three Mayo clinic sites (MN, FL and AZ) from 1996 to 2014 who had a graft that functioned for at least 2 years. We reviewed records to identify pregnancies and evaluated the risk graft failure, death-censored graft loss, doubling of urine protein and a decrease in eGFR by 50% in women with post-TX pregnancies as compared to matched controls (matched on parity and age at TX and year of TX). Cox proportional hazards models were used to calculate hazard ratios (HR) and 95% confidence intervals (CIs). Biopsies before and after pregnancy were reviewed.

Results

There were 818 women identified, of which 33 had at least 1 pregnancy lasting > 20 weeks gestation post-TX. The median time from TX to first delivery was 61 months (interquartile range (IQR) 35.5-76.5). Women with pregnancies were more likely to have pre-emptive TXs (51.5% vs. 24.2%, p=0.03) and lower nadir proteinuria post-TX (median 102 mg/24 hrs (IQR 67-153) vs. 135 mg/24 hrs (IQR 104-133), p=0.005) than women without pregnancies. There was no significant increase in the risk of graft failure (HR 0.49, 95% CI 0.12-1.23), death-censored graft loss (HR 0.60, 95% CI 0.23-1.57), or decrease in eGFR by 50% (HR 0.95, 95% CI 0.42-2.14) in women with pregnancies post-TX as compared to those without, even after adjusting for preemptive TX and baseline proteinuria. When adjusted for baseline proteinuria, there was a significant risk of doubling of proteinuria (adjusted HR 3.30, 95% CI 1.05-10.3). There was an increase in the number of biopsies with segmental sclerosis post-pregnancy (2 vs. 8). There was a significant mean (standard deviation) decrease in eGFR after pregnancy of 9 ml/min/1.73 m² (22.1) (p=0.03) and increase in women with eGFR < 45 ml/min/1.73 m² (3% vs. 37.5%, p=.002).

Conclusion

Women with preganancies after TX were more likely to have preemptive TXs and had lower baseline proteinuria than those without pregnancies. While pregnancy did not increase the risk of graft loss, there was a significant reduction in eGFR after pregnancy and an increased risk of doubling of proteinuria when adjusted for baseline values.

Funding

• Private Foundation Support