Risk of Adverse Maternal and Fetal Outcomes During Pregnancy in Living Kidney Donors: A Matched Cohort Study

Overview

Journal Clin Transplant

Specialty General Surgery

Date 2018 Nov 26

PMID 30472740

Citations 12

Authors

Scott Davis

James Dylewski

Pratik B Shah

John Holmen

Zhiying You

Michel Chonchol

Jessica Kendrick

Affiliations

Soon will be listed here.

Abstract

Background: We examined the risk of adverse pregnancy outcomes in primiparous kidney donors compared to matched controls.

Methods: Fifty-nine women with a history of kidney donation prior to their first pregnancy with normal renal function and no history of kidney disease, diabetes or chronic hypertension were matched 1:4 by age (within 2 years) and race to women with two kidneys using data from an integrated healthcare delivery system. Adverse pregnancy outcomes were defined as preterm delivery (delivery <37 weeks), delivery via cesarean section, gestational hypertension, preeclampsia/eclampsia, gestational diabetes, length of stay in the hospital >3 days, infant death/transfer to acute facility and low birthweight (<2500 g).

Results: Living kidney donors did not have a higher risk of adverse outcomes compared to matched controls. There was a trend toward an increased risk of preeclampsia/eclampsia in kidney donors but it did not reach statistical significance (Odds ratio [OR]: 2.96, 95% CI: 0.98-8.94, P = 0.06). However, in kidney donors ≤30 years of age, there was a fourfold increased risk of preeclampsia/eclampsia (OR: 4.09, 95% CI: 1.07-15.59, P = 0.04).

Conclusion: Overall, the risk of pregnancy-associated complications following kidney donation is small but potential female kidney donors should be counseled on the possible increased risk of preeclampsia.

Citing Articles

Living Donation and Pregnancy-Related Complications: State of the Evidence and Call To Action for Improved Risk Assessment.

Rossi A, Katz-Greenberg G, Coscia L, Brady C, Doligalski C, Irani R Clin J Am Soc Nephrol. 2024; 19(12):1659-1670.

PMID: 39652653 PMC: 11637692. DOI: 10.2215/CJN.0000000593.

Pregnancy Outcomes in Living Kidney Donors: Protocol of a Population-Based Cohort Study in Three Canadian Provinces.

Wang C, Naylor K, McArthur E, Sontrop J, Roshanov P, Lam N Can J Kidney Health Dis. 2024; 11:20543581241284030.

PMID: 39381072 PMC: 11459540. DOI: 10.1177/20543581241284030.

Pre-gestational counselling for women living with CKD: starting from the bright side.

Da Silva I, Orozco-Guillen A, Longhitano E, Ballarin J, Piccoli G Clin Kidney J. 2024; 17(5):sfae084.

PMID: 38711748 PMC: 11070880. DOI: 10.1093/ckj/sfae084.

Pregnancy in Living Kidney Donors: An Evidence-Based Review.

Artan A, Fleetwood V, Guller N, Oto O, Mirioglu S, Yazici H Curr Transplant Rep. 2023; 10(3):110-116.

PMID: 37743976 PMC: 10512453. DOI: 10.1007/s40472-023-00402-8.

The Minnesota attributable risk of kidney donation (MARKD) study: a retrospective cohort study of long-term (> 50 year) outcomes after kidney donation compared to well-matched healthy controls.

Vock D, Helgeson E, Mullan A, Issa N, Sanka S, Saiki A BMC Nephrol. 2023; 24(1):121.

PMID: 37127560 PMC: 10152793. DOI: 10.1186/s12882-023-03149-7.

References

Piccoli G, Attini R, Vasario E, Conijn A, Biolcati M, DAmico F . Pregnancy and chronic kidney disease: a challenge in all CKD stages. Clin J Am Soc Nephrol. 2010; 5(5):844-55. PMC: 2863984. DOI: 10.2215/CJN.07911109. View

Wrenshall L, McHugh L, Felton P, Dunn D, Matas A . Pregnancy after donor nephrectomy. Transplantation. 1996; 62(12):1934-6. DOI: 10.1097/00007890-199612270-00044. View

Duckitt K, Harrington D . Risk factors for pre-eclampsia at antenatal booking: systematic review of controlled studies. BMJ. 2005; 330(7491):565. PMC: 554027. DOI: 10.1136/bmj.38380.674340.E0. View

Kendrick J, Holmen J, You Z, Smits G, Chonchol M . Association of Unilateral Renal Agenesis With Adverse Outcomes in Pregnancy: A Matched Cohort Study. Am J Kidney Dis. 2017; 70(4):506-511. PMC: 5610923. DOI: 10.1053/j.ajkd.2017.02.367. View

Davison J, Dunlop W . Renal hemodynamics and tubular function normal human pregnancy. Kidney Int. 1980; 18(2):152-61. DOI: 10.1038/ki.1980.124. View

Piccoli G, Attini R, Vigotti F, Parisi S, Fassio F, Pagano A . Is renal hyperfiltration protective in chronic kidney disease-stage 1 pregnancies? A step forward unravelling the mystery of the effect of stage 1 chronic kidney disease on pregnancy outcomes. Nephrology (Carlton). 2014; 20(3):201-8. DOI: 10.1111/nep.12372. View

Zalba G, Fortuno A, Diez J . Oxidative stress and atherosclerosis in early chronic kidney disease. Nephrol Dial Transplant. 2006; 21(10):2686-90. DOI: 10.1093/ndt/gfl398. View

Reisaeter A, Roislien J, Henriksen T, Irgens L, Hartmann A . Pregnancy and birth after kidney donation: the Norwegian experience. Am J Transplant. 2008; 9(4):820-4. DOI: 10.1111/j.1600-6143.2008.02427.x. View

Ibrahim H, Akkina S, Leister E, Gillingham K, Cordner G, Guo H . Pregnancy outcomes after kidney donation. Am J Transplant. 2009; 9(4):825-34. PMC: 2747242. DOI: 10.1111/j.1600-6143.2009.02548.x. View

10.

Bruggeman L, Wu Z, Luo L, Madhavan S, Konieczkowski M, Drawz P . APOL1-G0 or APOL1-G2 Transgenic Models Develop Preeclampsia but Not Kidney Disease. J Am Soc Nephrol. 2016; 27(12):3600-3610. PMC: 5118487. DOI: 10.1681/ASN.2015111220. View

11.

Garg A, Muirhead N, Knoll G, Yang R, Prasad G, Thiessen-Philbrook H . Proteinuria and reduced kidney function in living kidney donors: A systematic review, meta-analysis, and meta-regression. Kidney Int. 2006; 70(10):1801-10. DOI: 10.1038/sj.ki.5001819. View

12.

. Official authorized errata for the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM). J Am Med Rec Assoc. 1983; 54(8):29-32. View

13.

Matas A, Smith J, Skeans M, Thompson B, Gustafson S, Schnitzler M . OPTN/SRTR 2012 Annual Data Report: kidney. Am J Transplant. 2013; 14 Suppl 1:11-44. DOI: 10.1111/ajt.12579. View

14.

Bianco A, Stone J, Lynch L, Lapinski R, BERKOWITZ G, Berkowitz R . Pregnancy outcome at age 40 and older. Obstet Gynecol. 1996; 87(6):917-22. DOI: 10.1016/0029-7844(96)00045-2. View

15.

Urschel S . Apples, oranges, and statistical magic: Limitations of registry studies and need for collaborative studies. J Heart Lung Transplant. 2015; 34(9):1136-8. DOI: 10.1016/j.healun.2015.05.013. View

16.

Hladunewich M, Kim S . Kidney Donation: What Might It Mean for Women Wishing to Become Pregnant. Am J Kidney Dis. 2015; 66(3):386-8. DOI: 10.1053/j.ajkd.2015.04.002. View

17.

Xu G, Luo K, Liu H, Huang T, Fang X, Tu W . The progress of inflammation and oxidative stress in patients with chronic kidney disease. Ren Fail. 2014; 37(1):45-9. DOI: 10.3109/0886022X.2014.964141. View

18.

Nevis I, Garg A . Maternal and fetal outcomes after living kidney donation. Am J Transplant. 2009; 9(4):661-8. DOI: 10.1111/j.1600-6143.2009.02623.x. View

19.

Josephson M . Transplantation: pregnancy after kidney donation: more questions than answers. Nat Rev Nephrol. 2009; 5(9):495-7. DOI: 10.1038/nrneph.2009.129. View

20.

Bodnar L, Ness R, Markovic N, Roberts J . The risk of preeclampsia rises with increasing prepregnancy body mass index. Ann Epidemiol. 2005; 15(7):475-82. DOI: 10.1016/j.annepidem.2004.12.008. View