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. 2024 Apr-Jun;46(2):e20230061.
doi: 10.1590/2175-8239-JBN-2023-0061en.

Pregnancy after kidney transplantation: 40 years single-center experience

[Article in English, Portuguese]
Eloísa Radaelli  1 , Gisele Meinerz  1   2 , Lázaro Pereira Jacobina  2 , Rosana Mussoi Bruno  1   2 , Juliana Alves Manhães de Andrade  1   2 , Valter Duro Garcia  2 , Elizete Keitel  1   2
Affiliations

Pregnancy after kidney transplantation: 40 years single-center experience

[Article in English, Portuguese]
Eloísa Radaelli et al. J Bras Nefrol. 2024 Apr-Jun.

Abstract
in English, Portuguese

Background: Kidney transplantation (KT) improves quality of life, including fertility recovery.

Objective: to describe outcomes of post-KT pregnancy and long-term patient and graft survival compared to a matched control group of female KT recipients who did not conceive.

Methods: retrospective single-center case-control study with female KT recipients from 1977 to 2016, followed-up until 2019.

Results: there were 1,253 female KT patients of childbearing age in the study period: 78 (6.2%) pregnant women (cases), with a total of 97 gestations. The median time from KT to conception was 53.0 (21.5 - 91.0) months. Abortion rate was 41% (spontaneous 21.6%, therapeutic 19.6%), preterm delivery, 32%, and at term delivery, 24%. Pre-eclampsia (PE) occurred in 42% of pregnancies that reached at least 20 weeks. The presence of 2 or more risk factors for poor pregnancy outcomes was significantly associated with abortions [OR 3.33 (95%CI 1.43 - 7.75), p = 0.007] and with kidney graft loss in 2 years. The matched control group of 78 female KT patients was comparable on baseline creatinine [1.2 (1.0 - 1.5) mg/dL in both groups, p = 0.95] and urine protein-to-creatinine ratio (UPCR) [0.27 (0.15 - 0.44) vs. 0.24 (0.02 - 0.30), p = 0.06]. Graft survival was higher in cases than in controls in 5 years (85.6% vs 71.5%, p = 0.012) and 10 years (71.9% vs 55.0%, p = 0.012) of follow-up.

Conclusion: pregnancy can be successful after KT, but there are high rates of abortions and preterm deliveries. Pre-conception counseling is necessary, and should include ethical aspects.

Histórico:: Transplante renal (TR) melhora qualidade de vida, incluindo recuperação da fertilidade.

Objetivo:: descrever desfechos gestacionais pós-TR e sobrevida de longo prazo da paciente e do enxerto renal comparada a um grupo controle pareado de receptoras de TR que não conceberam.

Métodos:: estudo retrospectivo caso-controle com receptoras de TR de 1977 a 2016, acompanhadas até 2019.

Resultados:: foram identificadas 1.253 receptoras de TR em idade fértil no período do estudo: 78 (6,2%) gestantes (casos), total de 97 gestações. Tempo mediano entre TR até concepção foi 53,0 (21,5 – 91,0) meses. Taxa de aborto foi 41% (espontâneo 21,6%, terapêutico 19,6%), parto prematuro, 32%, e a termo, 24%. Pré-eclâmpsia (PE) ocorreu em 42% das gestações que alcançaram pelo menos 20 semanas. Presença de 2 ou mais fatores de risco para desfechos gestacionais desfavoráveis foi significativamente associada a abortos [OR 3,33 (IC95% 1,43 – 7,75), p = 0,007] e perda de enxerto renal em 2 anos. O grupo controle de 78 mulheres com TR foi comparável na creatinina basal [1,2 (1,0 – 1,5) mg/dL nos dois grupos, p = 0,95] e na relação proteína/creatinina urinária (RPCU) [0,27 (0,15 – 0,44) vs. 0,24 (0,02 – 0,30), p = 0,06]. Sobrevida do enxerto foi maior nos casos que nos controles em 5 anos (85,6% vs. 71,5%, p = 0,012) e 10 anos (71,9% vs. 55,0%, p = 0,012) de acompanhamento.

Conclusão:: a gestação pode ser bem-sucedida após TR, mas existem altas taxas de abortos e partos prematuros. Aconselhamento pré-concepção é necessário e deve incluir aspectos éticos.

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Conflict of interest statement

Conflict of Interest The authors declare they have no conflict of interests.

Figures

Figure 1.
Figure 1.. Graft survival of female kidney transplant recipients in a 2-year follow-up after pregnancy, according to number of risk factors for poor pregnancy outcomes.
Figure 2.
Figure 2.. Graft survival according to period of kidney transplantation, before or after 2000, of cases plus controls (top panel), cases (mid panel) and controls (bottom panel).
Figure 3.
Figure 3.. Patient (top panel) and graft (bottom panel) survival of female kidney transplant recipients that did (cases) and did not (controls) conceive during follow-up.
See this image and copyright information in PMC

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