Pregnancy after Kidney Transplantation—Impact of Functional Renal Reserve, Slope of eGFR before Pregnancy, and Intensity of Immunosuppression on Kidney Function and Maternal Health

Autor: Rebecca Kaatz, Elisabetta Latartara, Friederike Bachmann, Nils Lachmann, Nadine Koch, Bianca Zukunft, Kaiyin Wu, Danilo Schmidt, Fabian Halleck, Peter Nickel, Kai-Uwe Eckardt, Klemens Budde, Stefan Verlohren, Mira Choi
Rok vydání: 2023
Předmět:
Zdroj: Journal of Clinical Medicine
Volume 12
Issue 4
Pages: 1545
ISSN: 2077-0383
DOI: 10.3390/jcm12041545
Popis: Women of childbearing age show increased fertility after kidney transplantation. Of concern, preeclampsia, preterm delivery, and allograft dysfunction contribute to maternal and perinatal morbidity and mortality. We performed a retrospective single-center study, including 40 women with post-transplant pregnancies after single or combined pancreas–kidney transplantation between 2003 and 2019. Outcomes of kidney function up to 24 months after the end of pregnancy were compared with a matched-pair cohort of 40 transplanted patients without pregnancies. With a maternal survival rate of 100%, 39 out of 46 pregnancies ended up with a live-born baby. The eGFR slopes to the end of 24 months follow-up showed mean eGFR declines in both groups (−5.4 ± 14.3 mL/min in pregnant versus −7.6 ± 14.1 mL/min in controls). We identified 18 women with adverse pregnancy events, defined as preeclampsia with severe end-organ dysfunction. An impaired hyperfiltration during pregnancy was a significant risk contributor for both adverse pregnancy events (p < 0.05) and deterioration of kidney function (p < 0.01). In addition, a declining renal allograft function in the year before pregnancy was a negative predictor of worsening allograft function after 24 months of follow-up. No increased frequency of de novo donor-specific antibodies after delivery could be detected. Overall, pregnancies in women after kidney transplantation showed good allograft and maternal outcomes.
Databáze: OpenAIRE
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