Abstract
Kidney transplantation (KT) may restore fertility in chronic kidney disease (CKD). The reasons why maternofetal outcomes are still inferior to the overall population are only partially known. Comparison with the CKD population may offer some useful insights for management and counselling.Aim of this study was to analyse the outcomes of pregnancy after KT, compared with a large population of nontransplanted CKD patients and with low-risk control pregnancies, observed in Italy the new millennium. We selected 121 live-born singletons after KT (Italian study group of kidney in pregnancy, national coverage about 75%), 610 live-born singletons in CKD, and 1418 low-risk controls recruited in 2 large Italian Units in the same period (2000-2014). The following outcomes were considered: maternal and fetal death; malformations; preterm delivery; small for gestational age (SGA) baby; need for the neonatal intensive care unit; doubling of serum creatinine or increase in CKD stage. Data were analyzed according to kidney diseases, renal function (staging according to CKD-epidemiology collaboration), hypertension, maternal age, parity, ethnicity. Maternofetal outcomes are less favourable in CKD and KT as compared with the low-risk population. CKD stage and hypertension are important determinants of results. Kidney transplantation patients with estimated glomerular filtration rate greater than 90 have worse outcomes compared with CKD stage 1 patients; the differences level off when only CKD patients affected by glomerulonephritis or systemic diseases ("progressive CKD") are compared with KT. In the multivariate analysis, risk for preterm and early-preterm delivery was linked to CKD stage (2-5 vs 1: relative risk 3.42 and 3.78) and hypertension (RR 3.68 and 3.16) while no difference was associated with being a KT or a CKD patient. The maternofetal outcomes in patients with kidney transplantation are comparable with those of nontransplanted CKD patients with similar levels of kidney function impairment and progressive and/or immunologic kidney disease.
Highlights
Among the many advantages of kidney transplantation over dialysis, pregnancy is of particular relevance for young patients, and successful delivery after transplantation is considered by patients and physicians as one of the main achievements of this therapy [1,2,3,4]
According to a recent in-depth systematic review that includes over 4,700 transplanted patients, post-Kidney transplantation (KT) pregnancy is feasible, but complication rates are still relatively high as compared to the general population in the USA [5]
E populations and of the controls, as well as to the lack of common terminology and of reliable measurements of kidney function in both physiological pregnancies and in pregnancies complicated by preeclampsia or kidney disease [21,22,23,24,25,26,27]
Summary
Among the many advantages of kidney transplantation over dialysis, pregnancy is of particular relevance for young patients, and successful delivery after transplantation is considered by patients and physicians as one of the main achievements of this therapy [1,2,3,4]. According to a recent in-depth systematic review that includes over 4,700 transplanted patients, post-KT pregnancy is feasible, but complication rates are still relatively high as compared to the general population in the USA [5]. The reasons for this are not fully understood: the presence of impaired renal function, hypertension. T function are at higher risk for adverse pregnancy-related outcomes, as is extensively P described in nontransplanted patients with CKD, the degree of risk has never been fully assessed [16,17,18,19,20] This is due to the high heterogeneity of the study. D a large population of non-transplanted CKD patients and with low-risk control E pregnancies, observed in Italy the new millennium
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