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, Ayse Serra Artan Istanbul University Istanbul Medical Faculty , İstanbul , Türkiye Search for other works by this author on: Oxford Academic Safak Mirioglu Division of Nephrology, Istanbul University Istanbul Faculty of Medicine, Department of Immunology, Istanbul University Aziz Sancar Institute of Experimental Medicine , Istanbul , Türkiye Search for other works by this author on: Oxford Academic Tuğba Saraç Sivrikoz Department of Obstetrics and Gynaecology, Istanbul University Istanbul Faculty of Medicine , Istanbul , Türkiye Search for other works by this author on: Oxford Academic Elif Ünal Department of Obstetrics and Gynaecology, Istanbul University Istanbul Faculty of Medicine , Istanbul , Türkiye Search for other works by this author on: Oxford Academic Rabia Hacer Hocaoglu Division of Nephrology, Istanbul University Istanbul Faculty of Medicine , Istanbul , Türkiye Search for other works by this author on: Oxford Academic Vafa Suleymanova Division of Nephrology, Istanbul University Istanbul Faculty of Medicine , Istanbul , Türkiye Search for other works by this author on: Oxford Academic Müge Doksan Division of Nephrology, Istanbul University Istanbul Faculty of Medicine , Istanbul , Türkiye Search for other works by this author on: Oxford Academic Ozgur Akin Oto Division of Nephrology, Istanbul University Istanbul Faculty of Medicine , Istanbul , Türkiye Search for other works by this author on: Oxford Academic Savas Ozturk Division of Nephrology, Istanbul University Istanbul Faculty of Medicine , Istanbul , Türkiye Search for other works by this author on: Oxford Academic Halil Yazici Division of Nephrology, Istanbul University Istanbul Faculty of Medicine , Istanbul , Türkiye Search for other works by this author on: Oxford Academic
Aydin Turkmen Division of Nephrology, Istanbul University Istanbul Faculty of Medicine , Istanbul , Türkiye Search for other works by this author on: Oxford Academic
Nephrology Dialysis Transplantation, Volume 39, Issue Supplement_1, May 2024, gfae069-0188-815, https://doi.org/10.1093/ndt/gfae069.188
Published:
23 May 2024
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Ayse Serra Artan, Safak Mirioglu, Tuğba Saraç Sivrikoz, Elif Ünal, Rabia Hacer Hocaoglu, Vafa Suleymanova, Müge Doksan, Ozgur Akin Oto, Savas Ozturk, Halil Yazici, Aydin Turkmen, #815 Maternal and fetal outcomes in kidney transplant recipients: a single-center observational study, Nephrology Dialysis Transplantation, Volume 39, Issue Supplement_1, May 2024, gfae069–0188–815, https://doi.org/10.1093/ndt/gfae069.188
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Abstract
Background and Aims
Pregnancy poses a high risk for adverse maternal and fetal outcomes in kidney transplant recipients (KTRs), and data on long-term allograft functions compared to healthy population are still limited. Therefore, we aimed to conduct a comparative analysis of maternal and fetal outcomes in KTRs with age-matched non-transplanted controls.
Method
In this retrospective single-center study, KTRs who experienced at least one pregnancy after transplantation between 1984 and 2016 were evaluated (study group). In order to create an age-matched control group, healthy women who had one pregnancy each and received prenatal care were included. Maternal and fetal outcomes were gestational age, preterm birth, newborn mortality, admittance to neonatal intensive care unit (NICU), Apgar scores, birth weight, and obstetric complications (preeclampsia, peripartum hemorrhage, duration of maternal hospitalization) in all pregnancies, and composite kidney outcome of KTRs which was defined as progression to graft failure necessitating dialysis or re-transplantation or doubling of serum creatinine at the end of follow-up.
Results
In 53 KTRs, 68 pregnancies occurred. Mean age at birth was 31.6 ± 5.2 for KTRs and 30.5 ± 5.8 for controls (p = 0.288). Preeclampsia (29.4% vs. 2.9%, p < 0.001) and preterm birth (57.4% vs. 32.4%, p = 0.003) were significantly higher in KTRs. KTR pregnancies had lower mean birth weight (2354 ± 814 vs. 2856 ± 729 mg, p = 0.001) and longer durations of maternal hospitalization (3 vs. 2 days, p = 0.001), as well. However, neonatal mortality, admittance to NICU, and peripartum hemorrhage rates and Apgar scores were similar (Table1). Baseline serum creatinine and eGFR levels of KTRs were 1 (0.8-1.2) mg/dl and 76.6 (59.9-91.5) ml/min/1.73 m2, respectively. Follow-up for a median of 105 months after the index birth showed higher serum creatinine levels at postpartum visits (p < 0.001) and last follow-up (p = 0.001) compared to baseline, with a tendency for increased proteinuria during pregnancies (Table2). Six KTRs (11.3%) experienced composite kidney outcomes, including 5 patients with graft failure and 1 with doubling of serum creatinine.
Conclusion
KTRs exhibit comparable neonatal mortality and NICU rates but higher rates of preeclampsia and preterm birth. Notably, graft functions worsen significantly during postpartum follow-up.
Table 1:
Maternal and fetal outcomes in all pregnancies.
| Outcomes | Study group (n = 68) | Control group (n = 68) | p value |
|---|---|---|---|
| Gestational week at birth, median (IQR) | 36 (34-38) | 38 (36-39) | <0.001 |
| Preterm birth, n (%) | 39 (57.4) | 22 (32.4) | 0.003 |
| Death of the newborn, n (%) | 3 (4.4) | 4 (5.9) | 0.698 |
| Admittance to neonatal ICU, n (%) | 17 (25) | 16 (23.5) | 0.841 |
| Apgar score at the first minute, median (IQR) | 7 (5-9) | 8 (7-8) | 0.341 |
| Apgar score at the fifth minute, median (IQR) | 9 (8-10) | 9 (9-9) | 0.751 |
| Birth weight of the newborn (mg), mean ± SD | 2354 ± 814 | 2856 ± 729 | 0.001 |
| Preeclampsia, n (%) | 20 (29.4) | 2 (2.9) | <0.001 |
| Peripartum hemorrhage, n (%) | 2 (2.9) | 1 (1.5) | 0.559 |
| Duration of maternal hospitalization (days), median (IQR) | 3 (2-4) | 2 (2-2.8) | 0.001 |
| Outcomes | Study group (n = 68) | Control group (n = 68) | p value |
|---|---|---|---|
| Gestational week at birth, median (IQR) | 36 (34-38) | 38 (36-39) | <0.001 |
| Preterm birth, n (%) | 39 (57.4) | 22 (32.4) | 0.003 |
| Death of the newborn, n (%) | 3 (4.4) | 4 (5.9) | 0.698 |
| Admittance to neonatal ICU, n (%) | 17 (25) | 16 (23.5) | 0.841 |
| Apgar score at the first minute, median (IQR) | 7 (5-9) | 8 (7-8) | 0.341 |
| Apgar score at the fifth minute, median (IQR) | 9 (8-10) | 9 (9-9) | 0.751 |
| Birth weight of the newborn (mg), mean ± SD | 2354 ± 814 | 2856 ± 729 | 0.001 |
| Preeclampsia, n (%) | 20 (29.4) | 2 (2.9) | <0.001 |
| Peripartum hemorrhage, n (%) | 2 (2.9) | 1 (1.5) | 0.559 |
| Duration of maternal hospitalization (days), median (IQR) | 3 (2-4) | 2 (2-2.8) | 0.001 |
Abbreviations: ICU: intensive care unit, IQR: interquartile range, SD: standard deviation.
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Table 1:
Maternal and fetal outcomes in all pregnancies.
| Outcomes | Study group (n = 68) | Control group (n = 68) | p value |
|---|---|---|---|
| Gestational week at birth, median (IQR) | 36 (34-38) | 38 (36-39) | <0.001 |
| Preterm birth, n (%) | 39 (57.4) | 22 (32.4) | 0.003 |
| Death of the newborn, n (%) | 3 (4.4) | 4 (5.9) | 0.698 |
| Admittance to neonatal ICU, n (%) | 17 (25) | 16 (23.5) | 0.841 |
| Apgar score at the first minute, median (IQR) | 7 (5-9) | 8 (7-8) | 0.341 |
| Apgar score at the fifth minute, median (IQR) | 9 (8-10) | 9 (9-9) | 0.751 |
| Birth weight of the newborn (mg), mean ± SD | 2354 ± 814 | 2856 ± 729 | 0.001 |
| Preeclampsia, n (%) | 20 (29.4) | 2 (2.9) | <0.001 |
| Peripartum hemorrhage, n (%) | 2 (2.9) | 1 (1.5) | 0.559 |
| Duration of maternal hospitalization (days), median (IQR) | 3 (2-4) | 2 (2-2.8) | 0.001 |
| Outcomes | Study group (n = 68) | Control group (n = 68) | p value |
|---|---|---|---|
| Gestational week at birth, median (IQR) | 36 (34-38) | 38 (36-39) | <0.001 |
| Preterm birth, n (%) | 39 (57.4) | 22 (32.4) | 0.003 |
| Death of the newborn, n (%) | 3 (4.4) | 4 (5.9) | 0.698 |
| Admittance to neonatal ICU, n (%) | 17 (25) | 16 (23.5) | 0.841 |
| Apgar score at the first minute, median (IQR) | 7 (5-9) | 8 (7-8) | 0.341 |
| Apgar score at the fifth minute, median (IQR) | 9 (8-10) | 9 (9-9) | 0.751 |
| Birth weight of the newborn (mg), mean ± SD | 2354 ± 814 | 2856 ± 729 | 0.001 |
| Preeclampsia, n (%) | 20 (29.4) | 2 (2.9) | <0.001 |
| Peripartum hemorrhage, n (%) | 2 (2.9) | 1 (1.5) | 0.559 |
| Duration of maternal hospitalization (days), median (IQR) | 3 (2-4) | 2 (2-2.8) | 0.001 |
Abbreviations: ICU: intensive care unit, IQR: interquartile range, SD: standard deviation.
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Table 2:
Kidney functions in kidney transplant recipients throughout the index pregnancy and at the last follow-up (n = 53).
| Variables | Before the pregnancy | First visit of the pregnancy | Immediately before the birth | Postpartum visit in the first month | Six months after the birth | Last follow-up | p value |
|---|---|---|---|---|---|---|---|
| Serum creatinine (mg/dl), median (IQR) | 1 (0.8-1.2) | 0.9 (0.8-1.2) | 1.1 (0.9-1.5) | 1.1 (0.9-1.5) | 1.1 (0.9-1.3) | 1.2 (0.9-1.5) | <0.001 |
| eGFR (ml/min/1.73 m2), median (IQR) | 76.6 (59.9-91.5) | 82.5 (59.8-94.7) | 67.8 (44.9-87.5) | 65.9 (47.6-79.7) | 67.3 (56.7-87.3) | 57.9 (42.5-78.3) | <0.001 |
| Proteinuria (mg/g or mg/day), median (IQR) | NA | 150 (116-180) | 200 (150-320) | 285 (170-445) | 220 (140-325) | 144 (76-426) | <0.001 |
| Variables | Before the pregnancy | First visit of the pregnancy | Immediately before the birth | Postpartum visit in the first month | Six months after the birth | Last follow-up | p value |
|---|---|---|---|---|---|---|---|
| Serum creatinine (mg/dl), median (IQR) | 1 (0.8-1.2) | 0.9 (0.8-1.2) | 1.1 (0.9-1.5) | 1.1 (0.9-1.5) | 1.1 (0.9-1.3) | 1.2 (0.9-1.5) | <0.001 |
| eGFR (ml/min/1.73 m2), median (IQR) | 76.6 (59.9-91.5) | 82.5 (59.8-94.7) | 67.8 (44.9-87.5) | 65.9 (47.6-79.7) | 67.3 (56.7-87.3) | 57.9 (42.5-78.3) | <0.001 |
| Proteinuria (mg/g or mg/day), median (IQR) | NA | 150 (116-180) | 200 (150-320) | 285 (170-445) | 220 (140-325) | 144 (76-426) | <0.001 |
Abbreviations: IQR: interquartile range, NA: not available.
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Table 2:
Kidney functions in kidney transplant recipients throughout the index pregnancy and at the last follow-up (n = 53).
| Variables | Before the pregnancy | First visit of the pregnancy | Immediately before the birth | Postpartum visit in the first month | Six months after the birth | Last follow-up | p value |
|---|---|---|---|---|---|---|---|
| Serum creatinine (mg/dl), median (IQR) | 1 (0.8-1.2) | 0.9 (0.8-1.2) | 1.1 (0.9-1.5) | 1.1 (0.9-1.5) | 1.1 (0.9-1.3) | 1.2 (0.9-1.5) | <0.001 |
| eGFR (ml/min/1.73 m2), median (IQR) | 76.6 (59.9-91.5) | 82.5 (59.8-94.7) | 67.8 (44.9-87.5) | 65.9 (47.6-79.7) | 67.3 (56.7-87.3) | 57.9 (42.5-78.3) | <0.001 |
| Proteinuria (mg/g or mg/day), median (IQR) | NA | 150 (116-180) | 200 (150-320) | 285 (170-445) | 220 (140-325) | 144 (76-426) | <0.001 |
| Variables | Before the pregnancy | First visit of the pregnancy | Immediately before the birth | Postpartum visit in the first month | Six months after the birth | Last follow-up | p value |
|---|---|---|---|---|---|---|---|
| Serum creatinine (mg/dl), median (IQR) | 1 (0.8-1.2) | 0.9 (0.8-1.2) | 1.1 (0.9-1.5) | 1.1 (0.9-1.5) | 1.1 (0.9-1.3) | 1.2 (0.9-1.5) | <0.001 |
| eGFR (ml/min/1.73 m2), median (IQR) | 76.6 (59.9-91.5) | 82.5 (59.8-94.7) | 67.8 (44.9-87.5) | 65.9 (47.6-79.7) | 67.3 (56.7-87.3) | 57.9 (42.5-78.3) | <0.001 |
| Proteinuria (mg/g or mg/day), median (IQR) | NA | 150 (116-180) | 200 (150-320) | 285 (170-445) | 220 (140-325) | 144 (76-426) | <0.001 |
Abbreviations: IQR: interquartile range, NA: not available.
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© The Author(s) 2024. Published by Oxford University Press on behalf of the ERA.
This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model)
Topic:
- pre-eclampsia
- pregnancy
- proteinuria
- hemodialysis
- renal transplantation
- apgar score
- birth weight
- fetus
- follow-up
- gestational age
- newborn
- intensive care unit
- neonatal intensive care units
- mothers
- postpartum period
- tissue transplants
- dialysis procedure
- kidney
- mortality
- prenatal care
- transplantation
- complications of pregnancy, childbirth and the puerperium
- premature birth
- neonatal mortality
- creatinine tests, serum
- serum creatinine level
- allografting
- peripartum hemorrhage
Issue Section:
E4 - COMPLICATIONS IN TRANSPLANTATION
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