Surveillance of pregnancy in women with a renal transplant
Marian Knight (NPEU)
Chris Rudge (UK Transplant), Catherine Nelson-Piercy (St Thomas' Hospital, London), Kate Bramham (Guy's and St Thomas' Hospital, London), Peter Brocklehurst (NPEU), Naomi Bush (NPEU (Former member)), Haiyan Gao (NPEU (Former member)), Jenny Kurinczuk (NPEU), Matthias Pierce (NPEU (Former member))
Severe maternal morbidity and mortality
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.
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.