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Kidney Week

Abstract: PO2598

Pregnancy Following Kidney Transplantation: Experience of a Tertiary Renal Obstetric Service Between 1996 and 2020

Session Information

Category: Women’s Health and Kidney Diseases

  • 2000 Women’s Health and Kidney Diseases


  • Gleeson, Sarah, Imperial NHS healthcare Trust, London, United Kingdom
  • Willicombe, Michelle, Imperial NHS healthcare Trust, London, United Kingdom
  • Hassan, Sevda, Imperial NHS healthcare Trust, London, United Kingdom
  • Christiadi, Daniel, Imperial NHS healthcare Trust, London, United Kingdom
  • Webster, Philip, Imperial NHS healthcare Trust, London, United Kingdom
  • Lightstone, Liz, Imperial NHS healthcare Trust, London, United Kingdom

Compared with dialysis, fertility & pregnancy outcomes are more favourable following transplantation. However, pregnancies post kidney transplant remain challenging with a risk of adverse maternal & obstetric outcomes


All transplanted patients attending the renal-obstetric clinic were identified from an in-house database. Further data were collected from their health records


We identified 52 pregnancies in 39 women. The mean age at delivery was 33±3 years. 57% were white, 17% black & 21% Asian. The cause of ESKD was glomerulonephritis (46%), reflux(17%), unknown/other(27%) & diabetes(10%).
3 patients (5%) miscarried & are not included in further analysis.
The mean time from transplantation to pregnancy was 84±56 months. The mean follow up after delivery is 6±5.2 years. The mean eGFR pre-pregnancy was 50.8; at 6 months, 1, 3 & 5 years it was was 49.4, 47.4, 48 & 52.9 ml/min. 1 graft was lost during pregnancy (pre-pregnancy eGFR 25, PCR 150); None were lost in the year postpartum. 5 women(12%) have subsequently lost their graft(mean of 4 years postpartum). 1 woman was presumptively treated for rejection during pregnancy; 2 were treated for rejection within 1 month post-partum. 6 others(14%) had a rejection episode - mean time of 38.6±42.4 months post-partum. There were no maternal deaths. 3/19 women checked for Donor Specific Antibodies(DSA) postpartum had a DSA- 1 present pre pregnancy & 2 de novo.
The mean gestational age was 35.7 weeks, with 43% born at term & 43% pre-term(5 born <34 weeks). 18 women(37%) developed preeclampsia. There was one intrauterine death. 66% delivered by caesarean section. The mean birth weight was 2400±588 grams; 24% were <10th percentile


Pregnancy outcomes in patients with transplants are better compared with those on dialysis(PMID: 27083278). However, complications still occur. The rate of preeclampsia (36%) is representative of the current literature & much higher than for women without transplants. Diagnosing preeclampsia in patients with pre-existing hypertension & proteinuria, as for many of our patients, remains challenging.
In our experience, reflected here, there are relatively low rates of rejection & graft loss but high rates of obstetric complications. We believe these patients are ideally managed in a joint renal obstetric clinic.