Abstract: FR-PO1150
Maternal, Fetal, and Kidney Outcomes in Delivery Hospitalizations Among Kidney Transplant Recipients: A Nationwide Study, 2016-2022
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: Transplantation
- 2002 Transplantation: Clinical
Author
- He, Mingyue, Baylor College of Medicine, Houston, Texas, United States
Background
Kidney transplantation (KT) improves quality of life and restores fertility in women with kidney failure; however, pregnancy after KT remains high risk. Contemporary national data are needed to inform pre-pregnancy counseling, antenatal surveillance, and peripartum management.
Methods
Using the National Inpatient Sample (2016-2022), we identified adult delivery hospitalizations among KT recipients not receiving dialysis and controls without chronic kidney disease (NCKD). We compared maternal characteristics, obstetric complications, fetal outcomes recorded during delivery hospitalization, in-hospital acute kidney injury (AKI), length of stay, and resource utilization. Multivariable regression was used to assess the association between KT status and adverse outcomes
Results
Among 25,016,672 delivery hospitalizations, 1,665 occurred among KT recipients and 24,989,317 among NCKD. Compared with NCKD controls, KT recipients were older (mean age 31 vs. 29 years) and had a higher burden of comorbidities, including preexisting hypertension (46.3% vs. 6.6%), preexisting diabetes (6.9% vs. 0.8%), and rheumatologic disease (9.3% vs. 0.4%). Cesarean delivery was more common among KT recipients than NCKD controls (56.0% vs. 32.1%).
Among KT recipients, pregnancy complications included gestational hypertension (3.6%), preeclampsia (14.7%), placental complications (5.1%), premature rupture of membranes (1.5%), venous thromboembolism (0.3%), postpartum hemorrhage (12.0%), postpartum infection or sepsis (2.1%), preterm labor (8.7%), and blood transfusion (7.8%). Fetal outcomes included fetal growth restriction (8.4%), fetal distress (32.4%), congenital anomalies (0.3%), and fetal death/stillbirth (2.7%). In-hospital AKI occurred in 8.1% of KT delivery hospitalizations, with no dialysis-requiring AKI identified. After multivariable adjustment, KT status was associated with higher odds of preeclampsia, cesarean delivery, preterm labor, postpartum hemorrhage, blood transfusion, placental complications, fetal distress, fetal growth restriction, fetal death, and AKI. KT recipients also had longer hospitalizations and greater resource utilization.
Conclusion
Compared with NCKD controls, KT recipients had higher risks of maternal, obstetric, fetal, and kidney complications during delivery hospitalization.