Abstract
Background Kidney transplantation (KT) may restore fertility in chronic kidney disease (CKD). The reasons why maternofetal outcomes are still inferior to the overall population are only partially known. Comparison with the CKD population may offer some useful insights for management and counselling. Aim of this study was to analyse the outcomes of pregnancy after KT, compared with a large population of nontransplanted CKD patients and with low-risk control pregnancies, observed in Italy the new millennium. Methods We selected 121 live-born singletons after KT (Italian study group of kidney in pregnancy, national coverage about 75%), 610 live-born singletons in CKD, and 1418 low-risk controls recruited in 2 large Italian Units in the same period (2000-2014). The following outcomes were considered: Maternal and fetal death; malformations; preterm delivery; small for gestational age (SGA) baby; need for the neonatal intensive care unit; doubling of serum creatinine or increase in CKD stage. Data were analyzed according to kidney diseases, renal function (staging according to CKD-epidemiology collaboration), hypertension, maternal age, parity, ethnicity. Results Maternofetal outcomes are less favourable in CKD and KT as compared with the low-risk population. CKD stage and hypertension are important determinants of results. Kidney transplantation patients with estimated glomerular filtration rate greater than 90 have worse outcomes compared with CKD stage 1 patients; the differences level off when only CKD patients affected by glomerulonephritis or systemic diseases ("progressive CKD") are compared with KT. In the multivariate analysis, risk for preterm and early-preterm delivery was linked to CKD stage (2-5 vs 1: Relative risk 3.42 and 3.78) and hypertension (RR 3.68 and 3.16) while no difference was associated with being a KT or a CKD patient. Conclusions The maternofetal outcomes in patients with kidney transplantation are comparable with those of nontransplanted CKD patients with similar levels of kidney function impairment and progressive and/or immunologic kidney disease.
| Original language | English |
|---|---|
| Pages (from-to) | 2536-2544 |
| Number of pages | 9 |
| Journal | Transplantation |
| Volume | 101 |
| Issue number | 10 |
| DOIs | |
| Publication status | Published - Oct 1 2017 |
Fingerprint
ASJC Scopus subject areas
- Transplantation
Cite this
Outcomes of Pregnancies after Kidney Transplantation : Lessons Learned from CKD. A Comparison of Transplanted, Nontransplanted Chronic Kidney Disease Patients and Low-Risk Pregnancies: A Multicenter Nationwide Analysis. / Piccoli, Giorgina Barbara; Cabiddu, Gianfranca; Attini, Rossella; Gerbino, Martina; Todeschini, Paola; Perrino, Maria Luisa; Manzione, Ana Maria; Piredda, Gian Benedetto; Gnappi, Elisa; Caputo, Flavia; Montagnino, Giuseppe; Bellizzi, Vincenzo; Di Loreto, Pierluigi; Martino, Francesca; Montanaro, Domenico; Rossini, Michele; Castellino, Santina; Biolcati, Marilisa; Fassio, Federica; Loi, Valentina; Parisi, Silvia; Versino, Elisabetta; Pani, Antonello; Todros, Tullia.
In: Transplantation, Vol. 101, No. 10, 01.10.2017, p. 2536-2544.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Outcomes of Pregnancies after Kidney Transplantation
T2 - Lessons Learned from CKD. A Comparison of Transplanted, Nontransplanted Chronic Kidney Disease Patients and Low-Risk Pregnancies: A Multicenter Nationwide Analysis
AU - Piccoli, Giorgina Barbara
AU - Cabiddu, Gianfranca
AU - Attini, Rossella
AU - Gerbino, Martina
AU - Todeschini, Paola
AU - Perrino, Maria Luisa
AU - Manzione, Ana Maria
AU - Piredda, Gian Benedetto
AU - Gnappi, Elisa
AU - Caputo, Flavia
AU - Montagnino, Giuseppe
AU - Bellizzi, Vincenzo
AU - Di Loreto, Pierluigi
AU - Martino, Francesca
AU - Montanaro, Domenico
AU - Rossini, Michele
AU - Castellino, Santina
AU - Biolcati, Marilisa
AU - Fassio, Federica
AU - Loi, Valentina
AU - Parisi, Silvia
AU - Versino, Elisabetta
AU - Pani, Antonello
AU - Todros, Tullia
PY - 2017/10/1
Y1 - 2017/10/1
N2 - Background Kidney transplantation (KT) may restore fertility in chronic kidney disease (CKD). The reasons why maternofetal outcomes are still inferior to the overall population are only partially known. Comparison with the CKD population may offer some useful insights for management and counselling. Aim of this study was to analyse the outcomes of pregnancy after KT, compared with a large population of nontransplanted CKD patients and with low-risk control pregnancies, observed in Italy the new millennium. Methods We selected 121 live-born singletons after KT (Italian study group of kidney in pregnancy, national coverage about 75%), 610 live-born singletons in CKD, and 1418 low-risk controls recruited in 2 large Italian Units in the same period (2000-2014). The following outcomes were considered: Maternal and fetal death; malformations; preterm delivery; small for gestational age (SGA) baby; need for the neonatal intensive care unit; doubling of serum creatinine or increase in CKD stage. Data were analyzed according to kidney diseases, renal function (staging according to CKD-epidemiology collaboration), hypertension, maternal age, parity, ethnicity. Results Maternofetal outcomes are less favourable in CKD and KT as compared with the low-risk population. CKD stage and hypertension are important determinants of results. Kidney transplantation patients with estimated glomerular filtration rate greater than 90 have worse outcomes compared with CKD stage 1 patients; the differences level off when only CKD patients affected by glomerulonephritis or systemic diseases ("progressive CKD") are compared with KT. In the multivariate analysis, risk for preterm and early-preterm delivery was linked to CKD stage (2-5 vs 1: Relative risk 3.42 and 3.78) and hypertension (RR 3.68 and 3.16) while no difference was associated with being a KT or a CKD patient. Conclusions The maternofetal outcomes in patients with kidney transplantation are comparable with those of nontransplanted CKD patients with similar levels of kidney function impairment and progressive and/or immunologic kidney disease.
AB - Background Kidney transplantation (KT) may restore fertility in chronic kidney disease (CKD). The reasons why maternofetal outcomes are still inferior to the overall population are only partially known. Comparison with the CKD population may offer some useful insights for management and counselling. Aim of this study was to analyse the outcomes of pregnancy after KT, compared with a large population of nontransplanted CKD patients and with low-risk control pregnancies, observed in Italy the new millennium. Methods We selected 121 live-born singletons after KT (Italian study group of kidney in pregnancy, national coverage about 75%), 610 live-born singletons in CKD, and 1418 low-risk controls recruited in 2 large Italian Units in the same period (2000-2014). The following outcomes were considered: Maternal and fetal death; malformations; preterm delivery; small for gestational age (SGA) baby; need for the neonatal intensive care unit; doubling of serum creatinine or increase in CKD stage. Data were analyzed according to kidney diseases, renal function (staging according to CKD-epidemiology collaboration), hypertension, maternal age, parity, ethnicity. Results Maternofetal outcomes are less favourable in CKD and KT as compared with the low-risk population. CKD stage and hypertension are important determinants of results. Kidney transplantation patients with estimated glomerular filtration rate greater than 90 have worse outcomes compared with CKD stage 1 patients; the differences level off when only CKD patients affected by glomerulonephritis or systemic diseases ("progressive CKD") are compared with KT. In the multivariate analysis, risk for preterm and early-preterm delivery was linked to CKD stage (2-5 vs 1: Relative risk 3.42 and 3.78) and hypertension (RR 3.68 and 3.16) while no difference was associated with being a KT or a CKD patient. Conclusions The maternofetal outcomes in patients with kidney transplantation are comparable with those of nontransplanted CKD patients with similar levels of kidney function impairment and progressive and/or immunologic kidney disease.
UR - http://www.scopus.com/inward/record.url?scp=85010840200&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85010840200&partnerID=8YFLogxK
U2 - 10.1097/TP.0000000000001645
DO - 10.1097/TP.0000000000001645
M3 - Article
C2 - 28114169
AN - SCOPUS:85010840200
VL - 101
SP - 2536
EP - 2544
JO - Transplantation
JF - Transplantation
SN - 0041-1337
IS - 10
ER -