Abstract: SA-PO036
Pregnancy Outcomes in Women with Kidney Transplant: Meta-Analysis and Systematic Review
Session Information
- Transplantation: Clinical Outcomes
October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 1802 Transplantation: Clinical
Authors
- Shah, Silvi, University of Cincinnati, Cincinnati, Ohio, United States
- Lalgudi venkatesan, Renganathan, University of Cincinnati, Cincinnati, Ohio, United States
- Gupta, Ayank, The University of Cincinnati, Cincinnati, Ohio, United States
- Kean, Emily B., University of Cincinnati, Cincinnati, Ohio, United States
- Sanghavi, Maitrik Kishor, University of Cincinnati, Cincinnati, Ohio, United States
- Grant, Tiffany J., University of Cincinnati, Cincinnati, Ohio, United States
- Gupta, Anu, Buffalo Medical Group, Buffalo, New York, United States
Background
Reproductive function in women with end stage renal disease generally improves after kidney transplant. However, pregnancy remains challenging due to the risk of adverse clinical outcomes. This systematic review aimed to determine the pregnancy outcomes in patients with kidney transplant, including live birth rate, nature and rates of maternal and fetal adverse events, and risk of graft failure.
Methods
We searched PubMed/MEDLINE, Elsevier EMBASE, Scopus, BIOSIS Previews, ISI Science Citation Index Expanded, and the Cochrane Central Register of Controlled Trials from their date of inception through August 2017 according to PRISMA guidelines for studies reporting incidence and outcomes of pregnancy in women with kidney transplant.
Results
Of 1343 unique studies, 87 met inclusion criteria, representing 6712 pregnancies in 4174 kidney transplant recipients. Mean maternal age was 29±2 years. The live-birth rate was 72.9% (95% CI 70.0-75.6). Other pregnancy outcomes included induced abortions (12.4%; 95% CI, 10.4-14.7), miscarriages (15.4%; 95% CI, 13.8-17.2), stillbirths (5.1%; 95% CI, 4.0-6.5), and ectopic pregnancies (2.4%; 95% CI, 1.5-3.7). Maternal complications that were determined included preeclampsia (21.5%; 95% CI, 18.5-24.9), gestational diabetes (5.7%, 95% CI 3.7-8.9), pregnancy induced hypertension (24.1%; 95% CI, 18.1-31.5), and cesarean section (62.6%, 95% CI 57.6-67.3). Fetal complications of preterm delivery was 43.1% (95% CI 38.7-47.6). Mean gestational age was 34.9 weeks, and mean birth weight was 2470 grams. With regards to graft outcomes, rate of acute rejection during pregnancy was 9.4% (95% CI, 6.4%-13.7%). Adverse pregnancy outcomes of cesarean section and neonatal deaths were highest, and live birth rate were less favorable in the 2-3 year interval as compared to 1-2 year and > 3 year interval following kidney transplant. Rates of spontaneous abortion were highest in women with mean maternal age < 25 years and > 35 years as compared to women aged 25-35 years.
Conclusion
Majority of pregnancies following kidney transplant are successful and do not have an adverse impact on fetal survival. However the risks of maternal and fetal complications are high in women with kidney transplant and should be considered in patient counseling and clinical decision making.