Surveillance of pregnancy in women with a renal transplant

Summary

Despite initial concerns about the advisability of pregnancy in solid-organ transplant recipients, there have now been reports of over 14,000 births to women with transplanted organs. Most studies are centre-based and retrospective. Recent analysis of data from the UK Transplant Pregnancy Register has identified high rates of preterm delivery (50%) and delivery by caesarean section (72%) in pregnant renal transplant recipients. Worse outcomes were associated with poorer pre-pregnancy graft function and drug-treated hypertension during pregnancy. This register, however, no longer collects information. The aim of this study was to collect information about pregnancy outcomes among a current cohort of all kidney transplant recipients in the UK.

Key findings

• There were 105 pregnancies identified in 101 recipients between January 1, 2007 and December 31, 2009.
• Preeclampsia developed in 24% compared with 4% of a comparison cohort.
• 52% of women with kidney transplants delivered preterm, significantly higher than the national rate of 8%.
• Twenty-four infants (24%) were small for gestational age (<10th centile).
• Potential predictive factors for poor pregnancy outcome included >1 previous kidney transplant (P=0.03), first trimester serum creatinine >125 mmol/L (P=0.001), and diastolic BP >90 mmHg in the second (P=0.002) and third trimesters (P=0.05).
• This study shows that most pregnancies in the UK in women with kidney transplants are successful but rates of maternal and neonatal complications remain high.

Publications

Journal Articles

• Bramham K, Nelson-Piercy C, Gao H, Pierce M, Bush N, Spark P, Brocklehurst P, Kurinczuk JJ, Knight M. Pregnancy in renal transplant recipients: a UK national cohort study. Clin J Am Soc Nephrol. 2013;8(2):290-8.