#1847 Pregnancy impact on kidney transplant outcome
Authors: Elkat Ahmed 
Published: May 2024

Abstract

Background and Aims
Renal transplantation improves the fertility of women of childbearing age. The possibility of a term pregnancy is one of the benefits of solid organ transplantation for women. Studies have also shown an increase in graft loss during and after pregnancy among sensitized patients and a higher risk of graft failure due to rejection in pregnancies occurring in the first and second-year post-transplantation. Most of these observations were found in studies using controls of non-pregnant recipients, but most did not match the study group in several critical clinical parameters, such as the gender of the controls, the creatinine level prepregnancy, or the cause of native kidney failure.
The aim of our study is to investigate the long-term effects of pregnancy on graft function in female renal transplant recipients at Mansoura Urology and Nephrology center who experienced pregnancy after kidney transplantation.

Method
Retrospective cohort study conducted on 236 patients out of 3000 kidney transplant recipient who underwent renal transplantation (RT) at Mansoura Urology and Nephrology Centre between March 1976 and December 2019. divided into group I; 118 kidney transplant female's recipient experienced pregnancy at any time after kidney transplant and Group II; 118 kidney transplant female's recipients who didn`t experience pregnancy after renal transplantation, they were matched according to age and duration of renal transplantation and comparable in primary immunosuppressant drugs. all kidney recipients were reviewed for preoperative & operative and post-operative details also we record maternal and fetal complication.

Results
Our study included 118 kidney transplant recipients who got pregnant 191 times, 64 kidney transplant recipients got pregnant for the second time, while 9 of them got pregnant for the third time. We retrospectively evaluated the maternal, fetal complications and evolution of graft function after each pregnancy. Main maternal complications were gestational hypertension developed in 87 pregnancy cases out of 191 (45.5%), preeclampsia (25.1%), UTI (18.8%), gestational DM (9.9%), and graft rejection during pregnancy (4.1%). Longer hemodialysis duration (OR: 0.45, p value: 0.05), Calcineurin-based immunosuppressive protocols (Tacrolimus; OR: 2.3, p value: 0.02; Cyclosporine; OR: 0.36, p value: 0.007), Proteinuria more than or equal to 0.5 g/day (OR: 5.4, p value: 0.001) and/or serum creatinine more than or equal to 1.3 mg/dl (OR: 3.75, p value: 0.001) before pregnancy and rising of serum creatinine and/or proteinuria (Proteinuria; OR: 20.84, p value: 0.001; serum creatinine ≥1.3 mg/dl; OR: 4.3, p value: 0.001) are important risk factors associated with gestational hypertension. The mean serum creatinine level pre-pregnancy (mean ± SD) was (0.9 ± 0.2) mg/dL and 24-hour urinary protein mean ± SD before pregnancy was (0.4 ± 0.2) g/day. Serum creatinine and 24-hour urinary protein were higher during and after pregnancy with a statistically significant difference when compared to before pregnancy data (P-value: 0.001), (P- value: 0.04) retrospectively.
At last follow-up, the majority of patients were alive with functioning graft with no statistically significant difference between two groups (P-value: 0.07), also no significant difference as regard graft failure incidence (p-value: 0.52).

Conclusion
Although the outcome of live births is favourable, the risks of maternal and fetal complications are high in kidney transplant recipients including pregnancy-induced hypertension, increased rates of preeclampsia, gestational diabetes, and caesarean section rates. The risk of miscarriage, prematurity, and low birth rate is also high. Serum creatinine and 24-hour urinary protein tend to increase during and after pregnancy which may impair the graft outcome. pregnancy counselling is necessary to avoid high-risk or unwanted pregnancies.