#815 Maternal and fetal outcomes in kidney transplant recipients: a single-center observational study

Abstract

Abstract Background and Aims Pregnancy poses a high risk for adverse maternal and fetal outcomes in kidney transplant recipients (KTRs), and data on long-term allograft functions compared to healthy population are still limited. Therefore, we aimed to conduct a comparative analysis of maternal and fetal outcomes in KTRs with age-matched non-transplanted controls. Method In this retrospective single-center study, KTRs who experienced at least one pregnancy after transplantation between 1984 and 2016 were evaluated (study group). In order to create an age-matched control group, healthy women who had one pregnancy each and received prenatal care were included. Maternal and fetal outcomes were gestational age, preterm birth, newborn mortality, admittance to neonatal intensive care unit (NICU), Apgar scores, birth weight, and obstetric complications (preeclampsia, peripartum hemorrhage, duration of maternal hospitalization) in all pregnancies, and composite kidney outcome of KTRs which was defined as progression to graft failure necessitating dialysis or re-transplantation or doubling of serum creatinine at the end of follow-up. Results In 53 KTRs, 68 pregnancies occurred. Mean age at birth was 31.6 ± 5.2 for KTRs and 30.5 ± 5.8 for controls (p = 0.288). Preeclampsia (29.4% vs. 2.9%, p < 0.001) and preterm birth (57.4% vs. 32.4%, p = 0.003) were significantly higher in KTRs. KTR pregnancies had lower mean birth weight (2354 ± 814 vs. 2856 ± 729 mg, p = 0.001) and longer durations of maternal hospitalization (3 vs. 2 days, p = 0.001), as well. However, neonatal mortality, admittance to NICU, and peripartum hemorrhage rates and Apgar scores were similar (Table 1). Baseline serum creatinine and eGFR levels of KTRs were 1 (0.8-1.2) mg/dl and 76.6 (59.9-91.5) ml/min/1.73 m2, respectively. Follow-up for a median of 105 months after the index birth showed higher serum creatinine levels at postpartum visits (p < 0.001) and last follow-up (p = 0.001) compared to baseline, with a tendency for increased proteinuria during pregnancies (Table 2). Six KTRs (11.3%) experienced composite kidney outcomes, including 5 patients with graft failure and 1 with doubling of serum creatinine. Conclusion KTRs exhibit comparable neonatal mortality and NICU rates but higher rates of preeclampsia and preterm birth. Notably, graft functions worsen significantly during postpartum follow-up.