Abstract
BackgroundAfter kidney transplantation, pregnancy and graft function may have a reciprocal interaction. We evaluated the influence of graft function on the course of pregnancy and vice versa.MethodsWe performed a retrospective observational study of 92 pregnancies beyond the first trimester in 67 women after renal transplantation from 1972 to 2019. Pre-pregnancy eGFR was correlated with outcome parameters; graft function was evaluated by Kaplan Meier analysis. The course of graft function in 28 women who became pregnant after kidney transplantation with an eGFR of < 50 mL/min/1.73m2 was compared to a control group of 79 non-pregnant women after kidney transplantation during a comparable time period and with a matched basal graft function.ResultsLive births were 90.5% (fetal death n = 9). Maternal complications of pregnancy were preeclampsia 24% (graft loss 1, fetal death 3), graft rejection 5.4% (graft loss 1), hemolytic uremic syndrome 2% (graft loss 1, fetal death 1), maternal hemorrhage 2% (fetal death 1), urinary obstruction 10%, and cesarian section. (76%). Fetal complications were low gestational age (34.44 ± 5.02 weeks) and low birth weight (2322.26 ± 781.98 g). Mean pre-pregnancy eGFR was 59.39 ± 17.62 mL/min/1.73m2 (15% of cases < 40 mL/min/1.73m2). Pre-pregnancy eGFR correlated with gestation week at delivery (R = 0.393, p = 0.01) and with percent eGFR decline during pregnancy (R = 0.243, p = 0.04). Pregnancy-related eGFR decline was inversely correlated with the time from end of pregnancy to chronic graft failure or maternal death (R = -0.47, p = 0.001). Kaplan Meier curves comparing women with pre-pregnancy eGFR of ≥ 50 to < 50 mL/min showed a significantly longer post-pregnancy graft survival in the higher eGFR group (p = 0.04). Women after kidney transplantation who became pregnant with a low eGFR of > 25 to < 50 mL/min/1.73m2 had a marked decline of renal function compared to a matched non-pregnant control group (eGFR decline in percent of basal eGFR 19.34 ± 22.10%, n = 28, versus 2.61 ± 10.95%, n = 79, p < 0.0001).ConclusionsAfter renal transplantation, pre-pregnancy graft function has a key role for pregnancy outcomes and graft function. In women with a low pre-pregnancy eGFR, pregnancy per se has a deleterious influence on graft function.Trial registrationSince this was a retrospective observational case series and written consent of the patients was obtained for publication, according to our ethics’ board the analysis was exempt from IRB approval. Clinical Trial Registration was not done. The study protocol was approved by the Ethics Committee of Hannover Medical School, Chairman Prof. Dr. H. D. Troeger, Hannover, December 12, 2015 (IRB No. 2995–2015).
Highlights
After kidney transplantation, pregnancy and graft function may have a reciprocal interaction
Pre-pregnancy estimated glomerular filtration rate (eGFR) correlated with gestation week at delivery (R = 0.393, p = 0.01; Fig. 1) and correlated with percent of loss of eGFR measured 3 to 4 months after pregnancy (R = 0.243, p = 0.04; Fig. 2)
To tackle the question whether pregnancy after kidney transplantation in women with low eGFR may have an adverse influence on graft function deterioration per se, we compared the change in graft function during the one-year-period of pregnancy with graft function during a one-year-period in a matched non-pregnant control group
Summary
Pregnancy and graft function may have a reciprocal interaction. Edith Helm had received a kidney from her identical twin sister, when both were 21 years old [1]. This case was the world’s third kidney transplant and Edith Helm became pregnant after the third post-transplant menstrual cycle [2]. She had a second pregnancy later and lived to age 76 years without immunosuppression. Pregnancy after non-living donor transplantation under immunosuppression was reported 11 years later [3]. Pregnancies after solid-organ transplants still are high-risk, but have become one of the expected benefits of transplantation [4]
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