ASN's Mission

ASN leads the fight to prevent, treat, and cure kidney diseases throughout the world by educating health professionals and scientists, advancing research and innovation, communicating new knowledge, and advocating for the highest quality care for patients.

learn more

Contact ASN

1401 H St, NW, Ste 900, Washington, DC 20005

email@asn-online.org

202-640-4660

The Latest on Twitter

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

Authors

  • 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
Background

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

Methods

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

Results

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

Conclusion

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.