Poster 11. Long term graft function and graft loss following pregnancy in kidney transplant recipients: a systematic review and meta-analysis.

Thursday 14 march 2019

13:00 - 13:03h

Categories: Klinisch, Postersessie

Parallel session: Postersessies 3 - Clinical

A.H. Schellekens1, M.C. van Buren2, J. van de Wetering2, F. van Reekum3, N.D. Paauw4, T.K.J. Groenhof5, A.T. Lely4

1Dept. of Gynaecology & Obstetrics, St. Antonius Hospital, Nieuwegein2Dept. of Internal Medicine, Nephrology & Kidney transplantation, Erasmus University Medical Center, Rotterdam3Dept. of Nephrology, University Medical Center Utrecht, Utrecht4Dept. of Obstetrics, University Medical Center Utrecht - Wilhelmina Children's Hospital, Utrecht.5Dept. of Cardiovascular Epidemiology, Julius Center, Utrecht, The Netherlands.

Background: The incidence of pregnancy in kidney transplant recipients is increasing. Although short-term graft outcomes are positive, less is known on long term effects of pregnancy on graft loss and serum creatinine. The aim of this study is to investigate the effect of pregnancy on graft function.

Methods: We conducted a systematic review scoping graft loss and serum creatinine change after pregnancy in kidney transplant recipients. Data that was extracted includes pre-pregnancy and post-pregnancy serum creatinine, whether graft loss occurred post-pregnancy and predictors of adverse outcome.

Results: Our search yielded 36 studies on graft loss after pregnancy and 19 articles on pre- and post-pregnancy serum creatinine. Pooled incidence of graft loss and mean change of serum creatinine pre- versus post pregnancy (delta serum creatinine (∆SCr) in different periods of time. Patient data was pooled by subcategories for graft loss and ∆SCr. Graft loss within two years post-pregnancy occurred in 7.0% of the cases, graft loss two to five years post-pregnancy in 9.2%, five to ten years 21.5% and graft loss more ten years post-pregnancy occurred in 33.6% of the patients. ∆SCr was significantly deteriorated in patients with short term follow up, less than two year post-pregnancy. Deterioration of SCr post-pregnancy compared to pre-pregnancy SCr within two year post-pregnancy is 0.10 mg/dL [0.02;0.28], p=0.01. In the other subcategories, follow up two to five year, and five to ten year post-pregnancy, no significant difference in ∆SCr was present. Compared to control groups no difference was found in graft loss and ∆SCr. Only a marginal increase of serum creatinine shortly after pregnancy was found in kidney transplant recipients. Reported predictors of adverse outcomes on graft function and risk of graft loss are hypertension prior to pregnancy, presence of proteinuria prior to pregnancy, preeclampsia, transplant to conception interval and higher level of serum creatinine prior to pregnancy.

Conclusions: The outcomes of graft loss and serum creatinine after pregnancy in kidney transplant recipients are reassuring. The findings of this meta-analysis are encouraging when we compare graft loss after pregnancy to graft loss in kidney transplantation recipients without pregnancy. It does not seem that pregnancy after kidney transplantation shortens graft survival.