Abstract
Women pregnant following kidney transplantation are at high risk of preeclampsia. Identifying the effects of preeclampsia on pregnancy outcome and allograft function in kidney transplanted women, and predicting which women will require more targeted follow-up and possible therapeutic intervention, could improve both maternal and neonatal outcome. In this retrospective cohort study of all pregnancies following kidney transplantation in Norway between 1969 and 2013, we used medical records to identify clinical characteristics predictive of preeclampsia. 175 pregnancies were included, in which preeclampsia was diagnosed in 65. Pregnancies with preeclampsia had significantly higher postpartum serum creatinine levels, higher risks of preterm delivery, caesarean delivery, and small for gestational age infants. In the final multivariate model chronic hypertension (aOR = 5.02 [95% CI, 2.47–10.18]), previous preeclampsia (aOR = 3.26 [95% CI, 1.43–7.43]), and elevated serum creatinine (≥125 μmol/L) at the start of pregnancy (aOR = 5.79 [95% CI, 1.91–17.59]) were prognostic factors for preeclampsia. Based on this model the risk was 19% when none of these factors were present, 45–59% risk when one was present, 80–87% risk when two were present, and 96% risk when all three were present. We suggest that the risk of preeclampsia in pregnancies in kidney transplanted women can be predicted with these variables, which are easily available at the start of pregnancy.
Highlights
Obstetric, perinatal and nephrologic care has improved since the first registered pregnancy in a kidney recipient in 1958 [1]
We investigated the effect of preeclampsia on pregnancy outcome and allograft function in kidney transplanted women
Based on a multivariate model, the study showed that chronic hypertension, elevated serum creatinine (sCr) at the start of pregnancy and previous preeclampsia were significant risk factors for preeclampsia in these women and could be used to build a simple prognostic score
Summary
Perinatal and nephrologic care has improved since the first registered pregnancy in a kidney recipient in 1958 [1]. Many questions still remain about how the pregnancy following kidney transplant affects the mother, child, and allograft. For the mother and child, both preeclampsia and the need for preterm delivery have potential negative long-term health effects, including increased risks for later diseases like diabetes, adiposity and cardiovascular disease [5,6,7]. Finding clinical characteristics that can lead to more accurate and early prediction of women at high risk of preeclampsia should be a first step in targeting prevention and follow-up. This may potentially decrease short and long-term complications
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