Pregnancy outcomes and complications after renal transplantation

Introduction. Chronic kidney disease (CKD) in pregnancy poses certain risks of both gestational complications and adverse perinatal outcomes, which increase with the decline of renal function.

Aim to access pregnancy outcomes in patients who underwent nephrotransplantation.

Materials and methods. Retrospective study of pregnant women who gave birth at Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology in the period from 2005 to 2021: 102 pregnancies in 97 patients were analyzed: five recipients had two successful pregnancies.

Results. The average age of pregnant women was 31 ± 4.03 years. In equal proportions, patients underwent related or cadaveric kidney transplantation – 52% (n = 53) and 48% (n = 49) of cases, respectively. The average delivery time was 35.5 ± 2.7 weeks. The average weight of newborns was 2545 ± 655 grams. Premature birth (PB) occurred in 47.1%, the average period of birth was 33.4 ± 2.87 weeks, of which early birth (<32 weeks) was 22.5%. The average period of pregnancy after transplantation was 5 ± 3.31 (1–18) years, this period was not associated with obstetric complications or deterioration of graft function. A significant increase in the following parameters was noted during pregnancy: serum creatinine level (p = 0.006), proteinuria (p = 0.003). The glomerular filtration rate also decreased significantly by the end of pregnancy (p = 0.011). Preeclampsia was the leading cause of decreased graft function during pregnancy (32.4%).

Conclusions. In general, pregnancy outcomes after nephrotransplantation are favorable, but there is an increased risk of preeclampsia, preterm birth, including operative delivery, urinary tract infection and anemia.

1. Saha MT, Saha HH, Niskanen LK, Salmela KT, Pasternack AI. Time course of serum prolactin and sex hormones following successful renal transplantation. Nephron. 2002;92(3):735–737. https://doi.org/10.1159/000064079.

2. Shah S, Verma P. Overview of Pregnancy in Renal Transplant Patients. Int J Nephrol. 2016;2016:4539342. https://doi.org/10.1155/2016/4539342.

3. Bramham K, Nelson-Piercy C, Gao H, Pierce M, Bush N, Spark P et al. Pregnancy in renal transplant recipients: a UK national cohort study. Clin J Am Soc Nephrol. 2013;8(2):290–298. https://doi.org/10.2215/CJN.06170612.

4. Coscia LA, Constantinescu S, Moritz MJ, Radomski JS, Gaughan WJ, McGrory CH, Armenti VT; National Transplantation Pregnancy Registry. Report from the National Transplantation Pregnancy Registry (NTPR): outcomes of pregnancy after transplantation. Clin Transpl. 2007:29–42. Available at: https://pubmed.ncbi.nlm.nih.gov/18642451.

5. Deshpande NA, James NT, Kucirka LM, Boyarsky BJ, Garonzik-Wang JM, Montgomery RA, Segev DL. Pregnancy outcomes in kidney transplant recipients: a systematic review and meta-analysis. Am J Transplant. 2011;11(11):2388–2404. https://doi.org/10.1111/j.1600-6143.2011.03656.x.

6. Shah S, Venkatesan RL, Gupta A, Sanghavi MK, Welge J, Johansen R et al. Pregnancy outcomes in women with kidney transplant: Metaanalysis and systematic review. BMC Nephrol. 2019;20(1):24. https://doi.org/10.1186/s12882-019-1213-5.

7. Martin JА, Hamilton BE, Osterman MJK. Births in the United States, 2016. NCHS Data Brief. 2017;(287):1–8. https://pubmed.ncbi.nlm.nih.gov/29155684

8. Kim HW, Seok HJ, Kim TH, Han DJ, Yang WS, Park SK. The experience of pregnancy after renal transplantation: pregnancies even within postoperative 1 year may be tolerable. Transplantation. 2008;85(10):1412–1419. https://doi.org/10.1097/TP.0b013e318170f8ed.

9. Vannevel V, Claes K, Baud D, Vial Y, Golshayan D, Yoon EW et al. Preeclampsia and Long-term Renal Function in Women Who Underwent Kidney Transplantation. Obstet Gynecol. 2018;131(1):57–62. https://doi.org/10.1097/AOG.0000000000002404.

10. Haas M, Mayer G. Cyclosporin A-associated hypertensionpathomechanisms and clinical consequences. Nephrol Dial Transplant. 1997;12(3):395–398. https://doi.org/10.1093/oxfordjournals.ndt.a027761.

11. Garlo K, Dressel D, Savic M, Vella J. Successful eculizumab treatment of recurrent postpartum atypical hemolytic uremic syndrome after kidney transplantation. Clin Nephrol Case Stud. 2015;3:8–13. https://doi.org/10.5414/CNCS108491.

12. Al-Otaibi T, Gheith OA, Nagib AM, Nair P, Zakaria ZE, Halim MA et al. Pregnancy After Renal Transplant: Single Center Experience From the Middle East in Patients Using Different Calcineurin Inhibitors. Exp Clin Transplant. 2019;17(Suppl 1):99–104. https://doi.org/10.6002/ect.MESOT2018.O42.

13. van Buren MC, Gosselink M, Groen H, van Hamersvelt H, de Jong M, de Borst MH et al. Effect of Pregnancy on eGFR After Kidney Transplantation: A National Cohort Study. Transplantation. 2022;106(6):1262–1270. https://doi.org/10.1097/TP.0000000000003932.

14. Atallah D, El Kassis N, Salameh C, Safi J, Bejjani L, Lutfallah F et al. Pregnancy and renal transplantation. J Med Liban. 2015;63(3):131–137. https://doi.org/10.12816/0015835.

15. Brown JH, Tellez J, Wilson V, Mackie IJ, Scully M, Tredger MM et al. Postpartum aHUS secondary to a genetic abnormality in factor H acquired through liver transplantation. Am J Transplant. 2012;12(6):1632–1636. https://doi.org/10.1111/j.1600-6143.2012.03991.x.

16. Forbes TA, Bradbury MG, Goodship TH, McKiernan PJ, Milford DV. Changing strategies for organ transplantation in atypical haemolytic uraemic syndrome: a tertiary case series. Pediatr Transplant. 2013;17(3):E93-9. https://doi.org/10.1111/petr.12066.

17. Kulagin AD, Ptushkin VV, Lukina EA, Davydkin IL, Korobkin AV, Shamrai VS et al. Randomized multicenter noninferiority phase III clinical trial of the first biosimilar of eculizumab. Ann Hematol. 2021;100(11):2689–2698. https://doi.org/10.1007/s00277-021-04624-7.

18. Ptushkin VV, Kulagin AD, Lukina EA, Davydkin IL, Konstantinova TS, Shamrai VS et al. Results of phase Ib open multicenter clinical trial of the safety, pharmacokinetics and pharmacodynamics of first biosimilar of eculizumab in untreated patients with paroxysmal nocturnal hemoglobinuria during induction of therapy. Terapevticheskii Arkhiv. 2020;92(7):77–84. (In Russ.) https://doi.org/10.26442/00403660.2020.07.000818.

19. Lavrishcheva IV, Jakovenko AA, Kudlay DA. A case report of atypical hemolytic-uremic syndrome treatment with the first Russian eculizumab in adult patient. Urology & Nephrology Open Access Journal. 2020;8(2):37–40. Available at: https://www.generium.ru/upload/preparations/elizariya/Lavrishcheva-IV-et-al.-aHUS-case-report_UNOAJ-08-00272.pdf?ysclid=luwplwxjrf570050976.

20. Korotchaeva YV, Kozlovskaya NL, Shifman EM. Comparative efficacy of the original and biosimilar eculizumab in the treatment of obstetric atypical hemolytic-uremic syndrome. Clinical Pharmacology and Therapy. 2021;30(3): 25–30. (In Russ.) https://doi.org/10.32756/0869-5490-2021-3-25-30.

21. Yang XJ, Sun SS. Comparison of maternal and fetal complications in elective and emergency cesarean section: a systematic review and meta-analysis. Arch Gynecol Obstet. 2017;296(3):503–512. https://doi.org/10.1007/s00404-017-4445-2.