Kidney Week

Abstract: FR-PO1173

Pregnancy Outcomes in Living Kidney Donors

Session Information

• Transplantation: Clinical - Transplant Access, Recipient Evaluation, Living Donors, Pregnancy, and More
  October 23, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Women's Health and Kidney Diseases

• 2100 Women's Health and Kidney Diseases

Authors

• Husain, Syed Ali, New York University, New York, New York, United States

Syed Ali Husain, MD, MA, MPH, FASN

• Patel, Suhani, New York University, New York, New York, United States

Suhani Patel, MPH

• Kucirka, Lauren M., The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States

Lauren M. Kucirka, MD, PhD

• Levan, Macey L., New York University, New York, New York, United States

Macey L. Levan, PhD, JD

• Mankowski, Michal, New York University, New York, New York, United States

Michal Mankowski, PhD

• Segev, Dorry L., New York University, New York, New York, United States

Dorry L. Segev, MD, PhD

• Massie, Allan, New York University, New York, New York, United States

Allan Massie, PhD

Group or Team Name

• Center for Surgical & Transplant Applied Research (CSTAR)

Background

Prior studies reported higher risk of pregnancy complications in living kidney donors (LKDs), presumably due to a loss of renal functional reserve; these studies have been limited by a small number of pregnancies or reliance on self-reported outcomes.

Methods

Using Epic Cosmos, a national database of >301M patients, we identified 1008 pregnancies in LKD and 10,000 pregnancies in selected controls weighted for age, race, and ethnicity with delivery summaries in the US. Pregnancy details were obtained from the delivery and birth summaries, lab values and vitals from visit records, and complications from ICD-10-CM codes with problem list diagnoses excluded. Multivariable Poisson regression was used to calculate the adjusted relative risk of severe maternal morbidity (SMM) for LKD vs controls.

Results

Among 1008 LKD pregnancies, 25% were <2y post-donation, 30% 2-5y post-donation, and 45% >5y post-donation. LKD were more likely to have pre-pregnancy hypertension (5.7% vs 4.0%). Median pre-pregnancy eGFR was 79 among LKD vs 114 among controls. Both groups had an increase in eGFR peaking at 4 months gestation (106 vs 127), with LKD displaying a larger increase vs controls (Fig1A). While blood pressure was similar between groups at baseline, sBP and dBP were higher in LKD from 5-8 months gestation (8mo sBP: 128 vs 124, dBP: 74 vs 73; Fig1B).

LKD were more likely to develop preeclampsia (13% vs 9%), proteinuria (1.5% vs 0.3%), AKI (1.4% vs 0.3%), and post-partum hemorrhage (5.3% vs 3.6%) (all p<0.01). LKD status was associated with a 70% increased adjusted risk of SMM (RR _1.311,70_2.17, p<0.001, Fig1C). LKD were less likely to deliver at gestational age ≥37 weeks (91.1% vs 93.8%), corresponding to lower newborn weight at birth (3249 vs 3325 g) and discharge.

Conclusion

LKDs had a 70% higher risk of SMMs compared to nondonors, though they displayed a similar eGFR trajectory during pregnancy.