Pregnancy in Renal Transplant Recipients: a UK National Cohort Study

Overview

Journal Clin J Am Soc Nephrol

Specialty Nephrology

Date 2012 Oct 23

PMID 23085724

Citations 53

Authors

Kate Bramham

Cathy Nelson-Piercy

Haiyan Gao

Matthias Pierce

Naomi Bush

Patsy Spark

Peter Brocklehurst

Jennifer J Kurinczuk

Marian Knight

Affiliations

Soon will be listed here.

Abstract

Background And Objectives: Most reports of pregnancy outcome in women with kidney transplants are single-center, retrospective, and include small numbers and few are compared with controls. The aim of this study was to collect information about pregnancy outcomes among all kidney transplant recipients in the United Kingdom, managed with current antenatal and nephrologic care, and to compare these data with a contemporaneous control group.

Design, Setting, Participants, & Measurements: Pregnant women with a kidney transplant were identified through the UK Obstetric Surveillance System (UKOSS) between January 1, 2007 and December 31, 2009. Data on a comparison cohort were obtained from the UKOSS database, containing information on comparison women identified in previous studies. Outcomes were also compared with national data.

Results: There were 105 pregnancies identified in 101 recipients. Median prepregnancy creatinine was 118 μmol/L. Preeclampsia developed in 24% compared with 4% of the comparison group. Median gestation at delivery was 36 weeks, with 52% of women delivering at <37 weeks, significantly higher than the national rate of 8%. Twenty-four infants (24%) were small for gestational age (<10th centile). There were two (2%) cases of acute rejection. Potential predictive factors for poor pregnancy outcome included >1 previous kidney transplant (P=0.03), first trimester serum creatinine >125 μmol/L (P=0.001), and diastolic BP >90 mmHg in the second (P=0.002) and third trimesters (P=0.05).

Conclusions: Most pregnancies in the United Kingdom in women with kidney transplants are successful but rates of maternal and neonatal complications remain high.

Citing Articles

Maternal and infant outcomes of pregnancy after kidney transplantation: a retrospective cohort study.

Zhang Y, Zhang L, Xia W, Fang L, Zhu T Arch Gynecol Obstet. 2025; .

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Kidney disease and reproductive health.

Smith P, Sarris I, Clark K, Wiles K, Bramham K Nat Rev Nephrol. 2024; 21(2):127-143.

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Family planning after transplantation: sex- and organ-related differences in the perception of medical counseling and social challenges.

Schirm N, Bohm L, Zimmermann T, Meyer N, von Versen-Hoynck F Arch Gynecol Obstet. 2024; 311(2):275-322.

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

Mustafa M, Noorani A, Abdul Rasool A, Tashrifwala F, Jayaram S, Raja S Womens Health (Lond). 2024; 20:17455057241277520.

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Maternal and neonatal outcomes in kidney transplant recipients: a single-center observational study.

Artan A, Mirioglu S, Unal E, Suleymanova V, Oto O, Ozturk S Wien Klin Wochenschr. 2024; 137(3-4):89-97.

PMID: 39231814 DOI: 10.1007/s00508-024-02425-2.

References

Davison J, Bailey D . Pregnancy following renal transplantation. J Obstet Gynaecol Res. 2003; 29(4):227-33. DOI: 10.1046/j.1341-8076.2003.00106.x. View

Rizzoni G, Ehrich J, Broyer M, Brunner F, Brynger H, Fassbinder W . Successful pregnancies in women on renal replacement therapy: report from the EDTA Registry. Nephrol Dial Transplant. 1992; 7(4):279-87. DOI: 10.1093/oxfordjournals.ndt.a092129. View

Knight M . Peripartum hysterectomy in the UK: management and outcomes of the associated haemorrhage. BJOG. 2007; 114(11):1380-7. DOI: 10.1111/j.1471-0528.2007.01507.x. View

Freeman J, Cole T, Chinn S, Jones P, White E, Preece M . Cross sectional stature and weight reference curves for the UK, 1990. Arch Dis Child. 1995; 73(1):17-24. PMC: 1511167. DOI: 10.1136/adc.73.1.17. View

Stratta P, Canavese C, Giacchino F, Mesiano P, Quaglia M, Rossetti M . Pregnancy in kidney transplantation: satisfactory outcomes and harsh realities. J Nephrol. 2004; 16(6):792-806. View

. European best practice guidelines for renal transplantation. Section IV: Long-term management of the transplant recipient. IV.10. Pregnancy in renal transplant recipients. Nephrol Dial Transplant. 2002; 17 Suppl 4:50-5. View

Knight M, Tuffnell D, Brocklehurst P, Spark P, Kurinczuk J . Incidence and risk factors for amniotic-fluid embolism. Obstet Gynecol. 2010; 115(5):910-917. DOI: 10.1097/AOG.0b013e3181d9f629. View

Knight M, Kurinczuk J, Tuffnell D, Brocklehurst P . The UK Obstetric Surveillance System for rare disorders of pregnancy. BJOG. 2005; 112(3):263-5. DOI: 10.1111/j.1471-0528.2005.00609.x. View

Cole T, Freeman J, Preece M . British 1990 growth reference centiles for weight, height, body mass index and head circumference fitted by maximum penalized likelihood. Stat Med. 1998; 17(4):407-29. View

10.

Sibanda N, Briggs J, Davison J, Johnson R, Rudge C . Pregnancy after organ transplantation: a report from the UK Transplant pregnancy registry. Transplantation. 2007; 83(10):1301-7. DOI: 10.1097/01.tp.0000263357.44975.d0. View

11.

McKay D, Josephson M . Pregnancy in recipients of solid organs--effects on mother and child. N Engl J Med. 2006; 354(12):1281-93. DOI: 10.1056/NEJMra050431. View

12.

Duley L, Henderson-Smart D, Meher S, King J . Antiplatelet agents for preventing pre-eclampsia and its complications. Cochrane Database Syst Rev. 2007; (2):CD004659. DOI: 10.1002/14651858.CD004659.pub2. View

13.

Luders C, Castro M, Titan S, de Castro I, Elias R, Abensur H . Obstetric outcome in pregnant women on long-term dialysis: a case series. Am J Kidney Dis. 2010; 56(1):77-85. DOI: 10.1053/j.ajkd.2010.01.018. View

14.

Aivazoglou L, Sass N, Silva Jr H, Sato J, Medina-Pestana J, de Oliveira L . Pregnancy after renal transplantation: an evaluation of the graft function. Eur J Obstet Gynecol Reprod Biol. 2010; 155(2):129-31. DOI: 10.1016/j.ejogrb.2010.11.020. View

15.

Fischer T, Neumayer H, Fischer R, Barenbrock M, Schobel H, Lattrell B . Effect of pregnancy on long-term kidney function in renal transplant recipients treated with cyclosporine and with azathioprine. Am J Transplant. 2005; 5(11):2732-9. DOI: 10.1111/j.1600-6143.2005.01091.x. View

16.

McKay D, Josephson M, Armenti V, August P, Coscia L, Davis C . Reproduction and transplantation: report on the AST Consensus Conference on Reproductive Issues and Transplantation. Am J Transplant. 2005; 5(7):1592-9. DOI: 10.1111/j.1600-6143.2005.00969.x. View

17.

Deshpande N, James N, Kucirka L, Boyarsky B, Garonzik-Wang J, Montgomery R . Pregnancy outcomes in kidney transplant recipients: a systematic review and meta-analysis. Am J Transplant. 2011; 11(11):2388-404. DOI: 10.1111/j.1600-6143.2011.03656.x. View

18.

Knight M . Antenatal pulmonary embolism: risk factors, management and outcomes. BJOG. 2008; 115(4):453-61. DOI: 10.1111/j.1471-0528.2007.01622.x. View

19.

Al-Khader A, Basri N, Al-Ghamdi , Shaheen , Hejaili , Flaiw . Pregnancies in renal transplant recipients--with a focus on babies. Ann Transplant. 2005; 9(3):65-7. View

20.

Hou S . Pregnancy in chronic renal insufficiency and end-stage renal disease. Am J Kidney Dis. 1999; 33(2):235-52. DOI: 10.1016/s0272-6386(99)70296-9. View