Abstract: SA-PO035
Incidence, Outcomes, and Predictors of Pregnancy in Kidney Transplant Recipients
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
- Christianson, Annette, University of Cincinnati, Cincinnati, Ohio, United States
- Meganathan, Karthikeyan, University of Cincinnati, Cincinnati, Ohio, United States
- Leonard, Anthony C., University of Cincinnati, Cincinnati, Ohio, United States
- Thakar, Charuhas V., University of Cincinnati, Cincinnati, Ohio, United States
Background
Although kidney transplant improves reproductive function in women with end stage renal disease (ESRD), pregnancy in kidney transplant recipients remains challenging due to risk of adverse outcomes. Temporal trends in pregnancy rate, fetal outcomes and its predictors in women with kidney transplants are not well studied.
Methods
We evaluated women aged 15-49 years who received a kidney transplant between 1/1/2005 and 12/31/2011 from the United States Renal Data System and who had Medicare as the primary payer for the entire 3 years after the date of transplantation or until graft failure or death. Temporal trends in pregnancy rates and fetal outcomes were studied. Case mix adjusted multivariate Poisson regression analysis was used to determine predictors of pregnancy.
Results
Overall, 308 pregnancies were identified in 9939 women. Mean maternal age was 30±7 year. Pregnancy rate was 11.4 per 1000 person-year (95% CI, 10.1-12.7). Pregnancy rates were roughly constant in the years 2005-2011. Of the known pregnancy outcomes, rate of live-birth was 42.6%, and stillbirth was 3.7%. Another 14.4% were reported as either live birth or stillbirth. Rate of spontaneous abortion was 32.4%, therapeutic abortion was 6.5% and ectopic pregnancy was 1.4%. Compared to women aged 25–29 years at time of conception, the pregnancy rate was lower in women aged 30–34 years (Incidence risk ratio [IRR], 0.56; CI, 0.41-0.77), 35-39 years (IRR, 0.16; CI 0.10-0.25), 40-44 years (IRR, 0.08; CI, 0.04-0.13), and 45-49 years (IRR, 0.06; CI, 0.03-0.10). Hispanic women had higher rates of pregnancy as compared to White women (IRR, 1.6; CI, 1.2-2.1). In transplant recipients, as compared to women with ESRD due to diabetes, pregnancy rate was higher in women with ESRD due to hypertension (IRR, 1.3; CI, 1.0-1.7), glomerulonephritis (IRR, 2.4; CI, 1.1-5.3), and cystic/hereditary diseases (IRR, 3.3; CI, 1.4-7.8). Women had higher rate of pregnancy in the second (IRR, 1.7; CI, 1.3-2.3) and third post transplant year (IRR, 1.7; CI, 1.3-2.3) as compared to first post transplant year.
Conclusion
Pregnancy in kidney transplant recipients is not uncommon and rates were relatively constant in in the last decade. Younger and Hispanic patients; and those with conception after the first post transplant had the highest rates of becoming pregnant.