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

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.

Automated summary

Women of childbearing age who have undergone kidney transplantation experience increased fertility, but are at risk for complications such as preeclampsia, preterm delivery, and allograft dysfunction. A retrospective study was conducted on 40 women who had post-transplant pregnancies between 2003 and 2019. The study found that the pregnancies had good outcomes for both the mothers and the transplanted kidneys, although there were declines in kidney function. Adverse pregnancy events, such as preeclampsia with severe end-organ dysfunction, were associated with impaired hyperfiltration during pregnancy and a decline in renal function. The frequency of de novo donor-specific antibodies did not increase after delivery.