Kidney graft function before pregnancy as a predictor of graft, maternal and fetal outcomes in pregnant renal transplant recipients

Filipe S. Mira; Joana Oliveira; Filipa Sousa; Dora Antunes; Ana Carolina Figueiredo; Andreia Borges; Maria S. J. Pais; Ana Galvão; Paulo Moura; Rui Alves

doi:10.1515/jpm-2021-0102

Article

Kidney graft function before pregnancy as a predictor of graft, maternal and fetal outcomes in pregnant renal transplant recipients

Filipe S. Mira , Joana Oliveira , Filipa Sousa , Dora Antunes , Ana Carolina Figueiredo , Andreia Borges , Maria S. J. Pais , Ana Galvão , Paulo Moura and Rui Alves

Published/Copyright: November 3, 2021

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From the journal Journal of Perinatal Medicine Volume 50 Issue 2

Abstract

Objectives

Maternal and fetal complications can occur in pregnant kidney transplant recipients. Since these are high-risk pregnancies, they require a multidisciplinary follow-up to prematurely detect adverse events. Identifying factors that would affect fetal, maternal and graft outcomes is essential to further stratify the risk of pregnant kidney transplant recipients.

Methods

All pregnancies in kidney transplant recipients followed in a single center for 30 years were included. Data included previous transplant information and blood and urine tests performed before pregnancy. Impact of graft function on fetal, maternal and graft outcomes was evaluated.

Results

There were 41 pregnancies among 34 patients. Mean gestational age of 35 ± 3 weeks. Caesarean section was performed in 69.4% of patients. Five pregnancies were unsuccessful (12.2%). Four patients suffered an acute graft dysfunction (9.8%) and 12 (29.3%) had a serious maternal hypertensive disorder (preeclampsia, eclampsia or HELLP syndrome). Graft function before pregnancy showed significant correlation with adverse outcomes.

Conclusions

A proteinuria >669 mg/g, serum creatinine >1.75 mg/dL and glomerular filtration rate <36.2 mL/min/1.73 m² before pregnancy were correlated to graft dysfunction during pregnancy. Similar values of proteinuria were also associated with a risk of maternal hypertensive disorders and pregnancy failure. Therefore, in patients with proteinuria and graft dysfunction, follow-up should be stricter to quickly detect complications.

Keywords: graft dysfunction; kidney transplant; preeclampsia; pregnancy

Corresponding author: Filipe S. Mira, MD, Nephrology Department, Coimbra University Hospital, Rua Alfredo Lopes Xisto, n° 36, 3000-020, Coimbra, Portugal; and Faculty of Medicine, University of Coimbra, Coimbra, Portugal, Phone: +351 932463036, E-mail: filipemira@netcabo.pt

Filipe S. Mira and Joana Oliveira contributed equally to this work and share first authorship.

Research funding: None declared.
Author contributions: FSM – Contributed in the analysis and interpretation of data as well as drafting, revising the article and provided critical intellectual input. JO – Contributed in the analysis and interpretation of data as well as drafting and revising the article. FS – Contributed in drafting and revising the article. DA – Contributed by providing critical intellectual input revising the article. ACF – Contributed in the analysis and interpretation of data. AB – Contributed by providing critical intellectual input revising the article. MSJP – Contributed by providing critical intellectual input revising the article. AG – Contributed in the analysis of data as well as drafting, revising the article and provided critical intellectual input. PM – Contributed in drafting and revising the article. RA – Contributed in the analysis of data as well as drafting, revising the article and provided critical intellectual input. All authors have accepted responsibility for the entire content of this manuscript and approved its submission.
Competing interest: Authors state no conflict of interest.
Informed consent: Not applicable.
Ethical approval: This research was conducted according to the Declaration of Helsinki and the Declaration of Istanbul ensuring that the anonymity of all patients was guaranteed.

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Received: 2021-02-25

Accepted: 2021-10-19

Published Online: 2021-11-03

Published in Print: 2022-02-23

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Articles in the same Issue

https://doi.org/10.1515/jpm-2021-0102

Keywords for this article

graft dysfunction; kidney transplant; preeclampsia; pregnancy