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Kidney Week

Abstract: PO2594

Reproductive Health in Kidney Transplant Recipients

Session Information

Category: Women’s Health and Kidney Diseases

  • 2000 Women’s Health and Kidney Diseases

Authors

  • Kattah, Andrea G., Mayo Clinic Minnesota, Rochester, Minnesota, United States
  • Cosio, Fernando G., Mayo Clinic Minnesota, Rochester, Minnesota, United States
  • Garovic, Vesna D., Mayo Clinic Minnesota, Rochester, Minnesota, United States
Background

Women with advanced chronic kidney disease develop menstrual irregularities and infertility that can improve after kidney transplant. However, some women do not have menstrual cycles return after transplant and pregnancy rates are lower than in the general population, which could be due to a combination of biologic and social factors.

Methods

We sent a survey on reproductive health to all women aged 18 to 44 at the time of transplant at all 3 Mayo Clinic sites between 1996 and 2014. We sent a second survey to all non-respondents from the first mailing and then called all remaining women to ask for their participation. We included questions on menstrual cycles, pregnancy, and menopause. Parity at the time of transplant was determined by chart review.

Results

There were 816 unique women, aged 18 to 44 at the time of transplant, in the period from 1996 to 2014. After excluding women who had passed away (n=91), and those with no current address or living outside the US (n=10), there were 715 eligibile women and 190 responded (26.6% response rate). Respondents were more likely to be white and to have had a pregnancy post-transplant. Only 10% of women reported a pregnancy post-transplant, though 14.2% reported actively pursuing pregnancy at some point. Nearly half (42.1%) of women said they were advised not to get pregnant, most often by a nephrologist. There were 61 pregnancies post-transplant, of which 80.1% were planned pregnancies. The majority of pregnancies resulted in livebirths (57%), and miscarriage occurred in 39% of pregnancies. Amenorrhea occurred in 34.2% of women pre-transplant, and 23% of these women did not have cycles return after transplant. The median (interquartile range) age of menopause was 44.5 (36-49) years.

Conclusion

While only 14.2% of respondents reported actively pursuing pregnancy after transplant, nearly half said they were advised not to pursue pregnancy, often by their nephrologists, which could in part explain low pregnancy rates in the kidney transplant population. While amenorrhea prior to transplant occurred in the minority of women, 23% of these women did not have menstrual cycles return post-transplant. Furthermore, the median age of menopause was much earlier than the general population. These findings suggest that kidney disease and/or transplantation itself may impact long-term gonadal function, which should be a target of future study.

Funding

  • Clinical Revenue Support