433. Kidney donation and transplantation-consequences for pregnancy

Abstract

The number of kidney transplantations (KT) and kidney donations is rising over the years. Pregnancy in KT recipients in increasing, generally pregnancy outcomes are good in kidney transplant recipients, but with high complication rates of hypertension, proteinuria and deterioration of graft function. Several voluntary registries and meta-analyses show on average 36 weeks of pregnancy, with preeclampsia rates of 30% and average birth weight of approximately 2500 grams. During pregnancy, physiological changes occur in the kidney, in healthy kidneys, glomerular filtration rate (GFR) increases from the first trimester, for more than 50% through an increase of renal blood flow. It is unknown which effect this temporary glomerular hyperfiltration has on long-term graft function. Data of a meta-analysis on this topic will be presented showing that a significant deterioration was seen in short term post-pregnancy graft function in serum creatinine of 0.10 mg/dL [0.02;0.28], p = 0.01. No long term deterioration of graft function was seen in this meta-analysis, supporting that pregnancy is safe in KT recipients. Pregnancy after kidney donation is increasing, but still rare. A recent publication showed that young female kidney donors have a significantly increased chance to develop gestational hypertension or preeclampsia [Garg, NEJM 2015], extending earlier research based on survey data, that showed differences in pregnancy complications, before and after donation. Several factors might potentially contribute to the increased risk for PE after kidney donation, i.e loss of kidney function, post-donation hypertension or loss of renal vasodilator capacity.