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. 2009 Nov;20(11):2433-40.
doi: 10.1681/ASN.2008121241. Epub 2009 Sep 24.

Pregnancy and maternal outcomes among kidney transplant recipients

Vicki Levidiotis  1 , Sean Chang, Stephen McDonald
Affiliations

Pregnancy and maternal outcomes among kidney transplant recipients

Vicki Levidiotis et al. J Am Soc Nephrol. 2009 Nov.

Abstract

Fertility rates, pregnancy, and maternal outcomes are not well described among women with a functioning kidney transplant. Using data from the Australian and New Zealand Dialysis and Transplant Registry, we analyzed 40 yr of pregnancy-related outcomes for transplant recipients. This analysis included 444 live births reported from 577 pregnancies; the absolute but not relative fertility rate fell during these four decades. Of pregnancies achieved, 97% were beyond the first year after transplantation. The mean age at the time of pregnancy was 29 +/- 5 yr. Compared with previous decades, the mean age during the last decade increased significantly to 32 yr (P < 0.001). The proportion of live births doubled during the last decade, whereas surgical terminations declined (P < 0.001). The fertility rate (or live-birth rate) for this cohort of women was 0.19 (95% confidence interval 0.17 to 0.21) relative to the Australian background population. We also matched 120 parous with 120 nulliparous women by year of transplantation, duration of transplant, age at transplantation +/-5 yr, and predelivery creatinine for parous women or serum creatinine for nulliparous women; a first live birth was not associated with a poorer 20-yr graft or patient survival. Maternal complications included preeclampsia in 27% and gestational diabetes in 1%. Taken together, these data confirm that a live birth in women with a functioning graft does not have an adverse impact on graft and patient survival.

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Figures

Figure 1.
Figure 1.
(A) Relative fertility (live birth) rates of women with a functioning kidney transplant in Australia, 1966 through 2005, are shown. (B) Relative fertility (95% CI) rates of transplant patients in Australia, 1966 through 2005 are shown.
Figure 2.
Figure 2.
Kaplan-Meier kidney graft survival estimates after a live birth by decade are shown.
Figure 3.
Figure 3.
Kaplan-Meier graft survival estimates in nulliparous and parous women with a kidney graft are shown. (A) Graft survival. (B) Survival with graft function.
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