Preeclampsia in kidney transplanted women; Outcomes and a simple prognostic risk score system

Women pregnant following kidney transplantation are at high risk of preeclampsia. Identifying the effects of preeclampsia on pregnancy outcome and allograft function in kidney transplanted women, and predicting which women will require more targeted follow-up and possible therapeutic intervention, could improve both maternal and neonatal outcome. In this retrospective cohort study of all pregnancies following kidney transplantation in Norway between 1969 and 2013, we used medical records to identify clinical characteristics predictive of preeclampsia. 175 pregnancies were included, in which preeclampsia was diagnosed in 65. Pregnancies with preeclampsia had significantly higher postpartum serum creatinine levels, higher risks of preterm delivery, caesarean delivery, and small for gestational age infants. In the final multivariate model chronic hypertension (aOR = 5.02 [95% CI, 2.47-10.18]), previous preeclampsia (aOR = 3.26 [95% CI, 1.43-7.43]), and elevated serum creatinine (>= 125 mu mol/ L) at the start of pregnancy (aOR = 5.79 [95% CI, 1.91 -17.59]) were prognostic factors for preeclampsia. Based on this model the risk was 19% when none of these factors were present, 45 -59% risk when one was present, 80 -87% risk when two were present, and 96% risk when all three were present. We suggest that the risk of preeclampsia in pregnancies in kidney transplanted women can be predicted with these variables, which are easily available at the start of pregnancy.