Abstract: TH-OR117
Pregnancy Outcomes After Living Kidney Donation
Session Information
- Late-Breaking Research Orals: Dialysis and Transplantation
October 22, 2026 | Location: Four Seasons Ballroom 2, Convention Center
Abstract Time: 05:30 PM - 05:42 PM
Category: Transplantation
- 2002 Transplantation: Clinical
Authors
- Garg, Amit X., Western University, London, Ontario, Canada
- Wang, Carol, Western University, London, Ontario, Canada
- Naylor, Kyla Lynn, Western University, London, Ontario, Canada
- McArthur, Eric, Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- King, James, University of Calgary, Calgary, Alberta, Canada
- Sontrop, Jessica M., Western University, London, Ontario, Canada
- Beyene, Joseph, McMaster University, Hamilton, Ontario, Canada
- Connaughton, Dervla M., Western University, London, Ontario, Canada
- Hendren, Elizabeth M., The University of British Columbia, Vancouver, British Columbia, Canada
- Hladunewich, Michelle A., University of Toronto, Toronto, Ontario, Canada
- Lam, Ngan, University of Calgary, Calgary, Alberta, Canada
- Lentine, Krista L., Saint Louis University School of Medicine, St. Louis, Missouri, United States
- Lyons, Rhiannon N., London Health Sciences Centre, London, Ontario, Canada
- Mcdonald, Sarah Diana, McMaster University, Hamilton, Ontario, Canada
- Roshanov, Pavel, Western University, London, Ontario, Canada
- Youngson, Erik, Data and Research Services, Edmonton, Alberta, Canada
Background
Females of childbearing age considering living kidney donation should be informed about potential pregnancy-related risks, but evidence is mixed and counselling practices vary. We examined whether pregnancies after living kidney donation have higher risks of adverse outcomes than matched pregnancies among nondonors with similar baseline health.
Methods
We conducted a retrospective matched cohort study using administrative health data from Ontario, British Columbia, and Alberta (protocol PMID 39381072). The cohort included 252 females aged 18–42 years who donated a kidney between July 1992 and August 2021 and had 385 post-donation singleton pregnancies of ≥20 weeks' gestation. These were matched 1:4 to 1540 pregnancies in 1535 nondonors with similar baseline health, based on delivery date, age at delivery, time from cohort entry to delivery, prior pregnancies, and income quintile. The primary outcome was gestational hypertension, preeclampsia, or eclampsia. Eleven secondary outcomes included components of the primary outcome, preterm birth or low birth weight, and small for gestational age.
Results
The primary outcome occurred more often among donors than nondonors (46/385 [11.9%] vs 128/1540 [8.3%]; risk ratio 1.5, 95% CI 1.1 to 2.1). Gestational hypertension and preeclampsia were also more common among donors when examined separately (risk ratio 1.5 for each); no donor developed eclampsia. Among pregnancies with the primary outcome, diagnoses were usually first recorded close to term (mean 38 weeks); gestational hypertensive disorders before 34 weeks' gestation were recorded in fewer than 2% of pregnancies in both groups. Most other maternal, fetal, and neonatal outcomes were similar between groups. Babies born to donors were more likely to be small for gestational age, whether defined as birth weight below the 10th percentile (13.8% vs 7.9%; risk ratio 1.9, 95% CI 1.4 to 2.5), 5th percentile (6.5% vs 3.6%; 1.8, 1.2 to 2.9), or 3rd percentile (4.7% vs 1.9%; 2.5, 1.4 to 4.4). Maternal death, stillbirth, and neonatal death among donors were rare.
Conclusion
Most pregnancies after living kidney donation were uncomplicated. Hypertensive disorders of pregnancy and small-for-gestational-age births were more common in donor pregnancies than in pregnancies among nondonors with similar baseline characteristics. These findings provide more precise risk estimates than previously available to inform donor counselling and care.
Acknowledgment
Grant support was provided by London Health Sciences Centre. Dr Naylor is supported by a CIHR Health System Impact Embedded Early Career Researcher Award. Dr Roshanov is supported by the Academic Medical Organization of Southwestern Ontario and the Dr William F Clark Chair in Nephrology. Carol Wang received support from PSI Foundation, Schulich Medicine & Dentistry, and KRESCENT. Dr Garg is supported by the Kay Family Chair in Transformational Kidney Care.