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Abstract: FR-PO857

Nationwide Pregnancy Outcomes After Kidney Transplantation and Prediction of Adverse Pregnancy Outcomes: A Dutch Cohort Study

Session Information

Category: Transplantation

  • 2002 Transplantation: Clinical

Authors

  • Gosselink, Margriet, Universitair Medisch Centrum Utrecht - Locatie Wilhelmina Kinderziekenhuis, Utrecht, Utrecht, Netherlands
  • Buren, Marleen Van, Erasmus MC, Rotterdam, Zuid-Holland, Netherlands
  • Kooiman, Judith, Universitair Medisch Centrum Utrecht - Locatie Wilhelmina Kinderziekenhuis, Utrecht, Utrecht, Netherlands
  • Groen, Henk, Universitair Medisch Centrum Groningen, Groningen, Groningen, Netherlands
  • Ganzevoort, Wessel, Amsterdam UMC Locatie AMC, Amsterdam, North Holland, Netherlands
  • Van Hamersvelt, Henk W., Radboudumc, Nijmegen, Gelderland, Netherlands
  • van der Heijden, Olivier Willem Hendrik, Radboudumc, Nijmegen, Gelderland, Netherlands
  • Van De Wetering, Jacqueline, Erasmus MC, Rotterdam, Zuid-Holland, Netherlands
  • Lely, Titia, Universitair Medisch Centrum Utrecht - Locatie Wilhelmina Kinderziekenhuis, Utrecht, Utrecht, Netherlands

Group or Team Name

  • PARTOUT working group
Background

Although numbers of pregnancy after kidney transplantation (KT) are rising, high risks of adverse pregnancy outcomes (APO) remain. Though important for preconceptional counselling and pregnancy monitoring, analyses on APO after KT per prepregnancy eGFR-CKD-categories have not been performed on a large scale before.

Methods

A Dutch nationwide cohort study investigated consecutive singleton pregnancies >20 weeks of gestation after KT between 1971-2017. Outcomes were analysed per prepregnancy eGFR-CKD-category. A composite adverse pregnancy outcome (cAPO) was established including birthweight <2500 gram, preterm birth <37 weeks, 3rd trimester severe hypertension (SBP >160 and/or DBP >110 mmHg) and/or >15% increase in serum creatinine (SCr) during pregnancy. Risk factors for cAPO were analysed in a multilevel model after multiple imputation of missing predictor values.

Results

288 pregnancies in 192 women were included. Total live birth was 93%, mean gestational age 35.6 weeks, mean birthweight 2383 gram. Independent risk factors for cAPO were prepregnancy eGFR, midterm percentage SCr dip and midterm mean arterial pressure dip; ORs 0.98 (95% CI 0.96–0.99), 0.95 (0.93-0.98) and 0.94 (0.90-0.98). cAPO was a risk indicator for graft loss (HR 2.55, 1.09-5.96) but no significant risk factor on its own when considering prepregnancy eGFR (HR 2.18, 0.92-5.13).

Conclusion

This was the largest and most comprehensive study of pregnancy outcomes after kidney transplantation. The novel analysis per eGFR-CKD-category, including pregnancies in women with poor kidney function, facilitates prepregnancy counselling. Overall obstetric outcomes are good. The risk of adverse outcomes is mainly dependent on prepregnancy graft function and hemodynamic adaptation to pregnancy.