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

Giorgina Barbara Piccoli, Gianfranca Cabiddu, Rossella Attini, Martina Gerbino, Paola Todeschini, Maria Luisa Perrino, Ana Maria Manzione, Gian Benedetto Piredda, Elisa Gnappi, Flavia Caputo, Giuseppe Montagnino, Vincenzo Bellizzi, Pierluigi Di Loreto, Francesca Martino, Domenico Montanaro, Michele Rossini, Santina Castellino, Marilisa Biolcati, Federica Fassio, Valentina LoiSilvia Parisi, Elisabetta Versino, Antonello Pani, Tullia Todros

Research output: Contribution to journalArticle

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 languageEnglish
Pages (from-to)2536-2544
Number of pages9
JournalTransplantation
Volume101
Issue number10
DOIs
Publication statusPublished - Oct 1 2017

Fingerprint

Pregnancy Outcome
Chronic Renal Insufficiency
Kidney Transplantation
Pregnancy
Kidney Diseases
Hypertension
Kidney
Population
Maternal Death
Fetal Death
Neonatal Intensive Care Units
Immune System Diseases
Maternal Age
Glomerulonephritis
Parity
Glomerular Filtration Rate
Italy
Gestational Age
Fertility
Counseling

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 journalArticle

Piccoli, GB, Cabiddu, G, Attini, R, Gerbino, M, Todeschini, P, Perrino, ML, Manzione, AM, Piredda, GB, Gnappi, E, Caputo, F, Montagnino, G, Bellizzi, V, Di Loreto, P, Martino, F, Montanaro, D, Rossini, M, Castellino, S, Biolcati, M, Fassio, F, Loi, V, Parisi, S, Versino, E, Pani, A & Todros, T 2017, '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', Transplantation, vol. 101, no. 10, pp. 2536-2544. https://doi.org/10.1097/TP.0000000000001645
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. / 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. In: Transplantation. 2017 ; Vol. 101, No. 10. pp. 2536-2544.
@article{c2a9698228f04d6d9574ddc559fba56b,
title = "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",
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.",
author = "Piccoli, {Giorgina Barbara} and Gianfranca Cabiddu and Rossella Attini and Martina Gerbino and Paola Todeschini and Perrino, {Maria Luisa} and Manzione, {Ana Maria} and Piredda, {Gian Benedetto} and Elisa Gnappi and Flavia Caputo and Giuseppe Montagnino and Vincenzo Bellizzi and {Di Loreto}, Pierluigi and Francesca Martino and Domenico Montanaro and Michele Rossini and Santina Castellino and Marilisa Biolcati and Federica Fassio and Valentina Loi and Silvia Parisi and Elisabetta Versino and Antonello Pani and Tullia Todros",
year = "2017",
month = "10",
day = "1",
doi = "10.1097/TP.0000000000001645",
language = "English",
volume = "101",
pages = "2536--2544",
journal = "Transplantation",
issn = "0041-1337",
publisher = "Lippincott Williams and Wilkins",
number = "10",

}

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 -