Abstract: TH-PO1019
Pregnancy Outcomes Following Living Kidney Donation: Sister-Matched Cohort Study
Session Information
- Women's Health and Kidney Diseases
November 06, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Women's Health and Kidney Diseases
- 2200 Women's Health and Kidney Diseases
Authors
- Alamri, Nada, Ministry of Health of Saudi Arabia, Madinah, Saudi Arabia
- Altirki, Zaynab Ali, Ministry of Health of Saudi Arabia, Madinah, Saudi Arabia
- Aleid, Hassan A., King Faisal Specialist Hospital and Research Centre, Riyadh, Riyadh Province, Saudi Arabia
Background
Women comprise approximately 60 % of living kidney donors worldwide, and nearly half donate while still of reproductive age. Pregnancy places substantial glomerular and cardiovascular demands on a single remaining kidney, fuelling concern that nephrectomy may heighten risks of hypertensive disorders and adverse fetal outcomes. Most prior studies compared donors with unrelated population controls, leaving unresolved genetic and socioeconomic confounding.
Methods
We undertook a retrospective matched-cohort study at a tertiary transplant centre. All female donors who conceived between 2007 and 2018 were paired 1 : 1 with their closest-aged biologic sisters (n = 343 pairs). Pregnancies were coded for composite fetal outcomes (live birth vs. abortion, stillbirth, neonatal death, pre-term delivery, major malformation, or intra-uterine fetal demise) and major maternal complications (pre-eclampsia, gestational hypertension, gestational diabetes, premature rupture of membranes, placental disorders). Donor pregnancies were further classified as pre-donation or post-donation.
Results
Among 1 067 pregnancies with complete data (donors = 714; sisters = 353) Fetal outcomes: Adverse events occurred in 28.2 % of donor pregnancies vs. 14.0 % of sister pregnancies (adjusted odds ratio [aOR] 2.35, 95 % CI 1.66–3.33; p < 0.001). Excess risk was already present before nephrectomy (33.6 %) and, while attenuated, persisted after donation (21.6 % vs. 14.0 %; aOR 1.57, 95 % CI 1.02–2.42; p = 0.04).
Maternal outcomes: Major complications were numerically lower in donors (7.9 %) than sisters (12.2 %; aOR 0.68, 95 % CI 0.42–1.10; p = 0.11). Sensitivity analyses restricted to pregnancies ≥ 2 years post-donation or to the first pregnancy per woman yielded similar findings.
Conclusion
Living kidney donors experienced roughly double the rate of adverse fetal outcomes compared with their sisters, yet the excess pre-dated nephrectomy and lessened afterwards, implying that familial or individual predisposition—rather than kidney donation itself—drives most of the risk. Maternal morbidity was not increased. These findings reassure prospective donors that pregnancy after nephrectomy is generally safe for mothers while underscoring the need for vigilant fetal monitoring in this population.