Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2024 Jan-Dec:20:17455057241277520.
doi: 10.1177/17455057241277520.

Pregnancy outcomes in renal transplant recipients: A systematic review and meta-analysis

Muhammad Saqlain Mustafa  1 , Amber Noorani  2 , Aniqa Abdul Rasool  3 , Fatema Ali Asgar Tashrifwala  4 , Shubha Jayaram  5 , Sandesh Raja  6 , Fatima Jawed  6 , Muhammad Usama Siddiq  1 , Sowmya Govindanahalli Shivappa  7 , Ishaque Hameed  6 , Sriharsha Dadana  8
Affiliations
Meta-Analysis

Pregnancy outcomes in renal transplant recipients: A systematic review and meta-analysis

Muhammad Saqlain Mustafa et al. Womens Health (Lond). 2024 Jan-Dec.

Abstract

Background: Kidney transplantation is a superior treatment for end-stage renal disease (ESRD), compared with hemodialysis, offering better quality of life and birth outcomes in women with ESRD and lower fertility rates.

Objectives: To investigate the pregnancy, maternal, fetal, and graft outcomes following kidney transplantation in women with ESRD and evaluate the improvements in quality of life and associated risks.

Design: A systematic review and meta-analysis performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and the Meta-analysis of Observational Studies in Epidemiology guidelines.

Data sources and methods: A thorough search of multiple databases, including PubMed, Embase, Scopus, ATC abstracts, and Cochrane Central Register of Controlled Trials, was conducted to identify studies that analyzed pregnancy outcomes in kidney transplant patients. The search was conducted from the inception of each database to January 2023.

Results: The study reviewed 109 studies that evaluated 7708 pregnancies in 5107 women who had undergone renal transplantation. Of these, 78.48% resulted in live births, 9.68% had induced abortion, and 68.67% had a cesarean section. Miscarriage occurred in 12.54%, preeclampsia in 20.87%, pregnancy-induced hypertension in 24.30%, gestational diabetes in 5.08%, and preterm delivery in 45.30% of cases. Of the 853 recipients, 123 had graft loss after pregnancy and 8.06% suffered acute rejection.

Conclusion: Pregnancy after kidney transplantation is associated with risks for mother and fetus; however, live births are still possible. In addition, there are reduced overall risks of stillbirths, miscarriages, neonatal deaths, and gestational diabetes.

Registration: PROSPERO (CRD42024541659).

Keywords: graft outcomes; live births; neonatal mortality; preeclampsia; pregnancy; renal transplant.

PubMed Disclaimer

Conflict of interest statement

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
PRISMA flow chart summarizing the systematic review process according to PRISMA guidelines, showing the number of records identified, screened, assessed for eligibility, and included in the systematic review and meta-analysis. PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-Analyses.
Figure 2.
Figure 2.
Forest plot illustrating the incidence of live births among kidney transplant recipients, both globally and within distinct geographical regions.
Figure 3.
Figure 3.
Forest plot illustrating the occurrence of induced abortions among kidney transplant recipients overall and in various geographical regions.
Figure 4.
Figure 4.
Forest plot illustrating the incidence of miscarriages among kidney transplant recipients overall and in diverse geographical regions.
Figure 5.
Figure 5.
Forest plot depicting the occurrence of stillbirths among kidney transplant recipients overall and across various geographical regions.
Figure 6.
Figure 6.
Forest plot illustrating the outcomes of ectopic pregnancies among kidney transplant recipients both overall and across different geographical regions.
Figure 7.
Figure 7.
Forest plot displaying the outcomes of cesarean sections among kidney transplant recipients overall, as well as across different geographical regions.
Figure 8.
Figure 8.
Forest plot depicting the occurrence of preeclampsia among kidney transplant recipients overall and in various geographical regions.
Figure 9.
Figure 9.
Forest plot illustrating the incidence of gestational diabetes among kidney transplant recipients overall and across diverse geographical regions.
Figure 10.
Figure 10.
Forest plot demonstrating the occurrence of pregnancy-induced hypertension among kidney transplant recipients overall and in various geographical regions.
Figure 11.
Figure 11.
Forest plot illustrating the occurrence of preterm births among kidney transplant recipients overall and across various geographical regions.
Figure 12.
Figure 12.
Forest plot illustrating the occurrence of neonatal mortality among kidney transplant recipients overall and across diverse geographical regions.
Figure 13.
Figure 13.
Forest plot displaying the rates of acute rejection among kidney transplant recipients overall and across various geographical regions.
See this image and copyright information in PMC

References

    1. Piccoli GB, Cabiddu G, Attini R, et al.. Outcomes of pregnancies after kidney transplantation: lessons learned from CKD. A comparison of transplanted, non-transplanted chronic kidney disease patients and low-risk pregnancies: a multicenter nationwide analysis. Transplantation 2017; 101: 2536–2544. - PubMed
    1. Chittka D, Hutchinson JA. Pregnancy after renal transplantation. Transplantation 2017; 101: 675–678. - PMC - PubMed
    1. Webster P, Lightstone L, McKay DB, et al.. Pregnancy in chronic kidney disease and kidney transplantation. Kidney Int 2017; 91: 1047–1056. - PubMed
    1. Shah S, Verma P. Overview of pregnancy in renal transplant patients. Int J Nephrol 2016; 2016: 4539342. - PMC - PubMed
    1. You JY, Kim MK, Choi SJ, et al.. Predictive factors for adverse pregnancy outcomes after renal transplantation. Clin Transplant 2014; 28: 699–706. - PubMed

MeSH terms

LinkOut - more resources