Pregnancy outcomes after kidney graft in Italy

Are the changes over time the result of different therapies or of different policies? A nationwide survey (1978-2013)

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 Loi & 4 others Silvia Parisi, Elisabetta Versino, Antonello Pani, Tullia Todros

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

BackgroundKidney transplantation is the treatment of choice to restore fertility to women on renal replacement therapy. Over time, immunosuppressive, support therapies and approaches towards high-risk pregnancies have changed. The aim of this study was to analyse maternal-foetal outcomes in two cohorts of transplanted women who delivered a live-born baby in Italy in 1978-2013, dichotomized into delivery before and after January 2000. MethodsA survey involving all the Italian transplant centres was carried out, gathering data on all pregnancies recorded since the start of activity at each centre; the estimated nationwide coverage was 75%. Data on cause of ESRD, dialysis, living/cadaveric transplantation, drug therapy, comorbidity, and the main maternal-foetal outcomes were recorded and reviewed. Data were compared with a low-risk cohort of pregnancies from two large Italian centres (2000-14; Torino and Cagliari Observational Study cohort). ResultsThe database consists of 222 pregnancies with live-born babies after transplantation (83 before 2000 and 139 in 2000-13; 68 and 121 with baseline and birth data, respectively), and 1418 low-risk controls. The age of the patients significantly increased over time (1978-99: age 30.7 ± 3.7 versus 34.1 ± 3.7 in 2000-13; P < 0.001). Azathioprine, steroids and cyclosporine A were the main drugs employed in the first time period, while tacrolimus emerged in the second. The prevalence of early preterm babies increased from 13.4% in the first to 27.1% in the second period (P = 0.049), while late-preterm babies non-significantly decreased (38.8 versus 33.1%), thus leaving the prevalence of all preterm babies almost unchanged (52.2 and 60.2%; P = 0.372). Babies below the 5th percentile decreased over time (22.2 versus 9.6%; P = 0.036). In spite of high prematurity rates, no neonatal deaths occurred after 2000. The results in kidney transplant patients are significantly different from controls both considering all cases [preterm delivery: 57.3 versus 6.3%; early preterm: 22.2 versus 0.9%; small for gestational age (SGA): 14 versus 4.5%; P < 0.001] and considering only transplant patients with normal kidney function [preterm delivery: 35 versus 6.3%; early preterm: 10 versus 0.9%; SGA: 23.7 versus 4.5% (P < 0.001); risks increase across CKD stages]. Kidney function remained stable in most of the patients up to 6 months after delivery. Multiple regression analysis performed on the transplant cohort highlights a higher risk of preterm delivery in later CKD stages, an increase in preterm delivery and a decrease in SGA across periods. ConclusionsPregnancy after transplantation has a higher risk of adverse outcomes compared with the general population. Over time, the incidence of SGA babies decreased while the incidence of 'early preterm' babies increased. Although acknowledging the differences in therapy (cyclosporine versus tacrolimus) and in maternal age (significantly increased), the decrease in SGA and the increase in prematurity may be explained by an obstetric policy favouring earlier delivery against the risk of foetal growth restriction.

Original languageEnglish
Pages (from-to)1957-1965
Number of pages9
JournalNephrology Dialysis Transplantation
Volume31
Issue number11
DOIs
Publication statusPublished - Nov 1 2016

Fingerprint

Pregnancy Outcome
Italy
Gestational Age
Transplants
Kidney
Transplantation
Tacrolimus
Pregnancy
Cyclosporine
Therapeutics
Mothers
High-Risk Pregnancy
Renal Replacement Therapy
Incidence
Maternal Age
Azathioprine
Immunosuppressive Agents
Fetal Development
Obstetrics
Chronic Kidney Failure

ASJC Scopus subject areas

  • Nephrology
  • Transplantation

Cite this

Pregnancy outcomes after kidney graft in Italy : Are the changes over time the result of different therapies or of different policies? A nationwide survey (1978-2013). / 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: Nephrology Dialysis Transplantation, Vol. 31, No. 11, 01.11.2016, p. 1957-1965.

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 2016, 'Pregnancy outcomes after kidney graft in Italy: Are the changes over time the result of different therapies or of different policies? A nationwide survey (1978-2013)', Nephrology Dialysis Transplantation, vol. 31, no. 11, pp. 1957-1965. https://doi.org/10.1093/ndt/gfw232
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. / Pregnancy outcomes after kidney graft in Italy : Are the changes over time the result of different therapies or of different policies? A nationwide survey (1978-2013). In: Nephrology Dialysis Transplantation. 2016 ; Vol. 31, No. 11. pp. 1957-1965.
@article{e23fd140687a4d5aa17978e7d44554a2,
title = "Pregnancy outcomes after kidney graft in Italy: Are the changes over time the result of different therapies or of different policies? A nationwide survey (1978-2013)",
abstract = "BackgroundKidney transplantation is the treatment of choice to restore fertility to women on renal replacement therapy. Over time, immunosuppressive, support therapies and approaches towards high-risk pregnancies have changed. The aim of this study was to analyse maternal-foetal outcomes in two cohorts of transplanted women who delivered a live-born baby in Italy in 1978-2013, dichotomized into delivery before and after January 2000. MethodsA survey involving all the Italian transplant centres was carried out, gathering data on all pregnancies recorded since the start of activity at each centre; the estimated nationwide coverage was 75{\%}. Data on cause of ESRD, dialysis, living/cadaveric transplantation, drug therapy, comorbidity, and the main maternal-foetal outcomes were recorded and reviewed. Data were compared with a low-risk cohort of pregnancies from two large Italian centres (2000-14; Torino and Cagliari Observational Study cohort). ResultsThe database consists of 222 pregnancies with live-born babies after transplantation (83 before 2000 and 139 in 2000-13; 68 and 121 with baseline and birth data, respectively), and 1418 low-risk controls. The age of the patients significantly increased over time (1978-99: age 30.7 ± 3.7 versus 34.1 ± 3.7 in 2000-13; P < 0.001). Azathioprine, steroids and cyclosporine A were the main drugs employed in the first time period, while tacrolimus emerged in the second. The prevalence of early preterm babies increased from 13.4{\%} in the first to 27.1{\%} in the second period (P = 0.049), while late-preterm babies non-significantly decreased (38.8 versus 33.1{\%}), thus leaving the prevalence of all preterm babies almost unchanged (52.2 and 60.2{\%}; P = 0.372). Babies below the 5th percentile decreased over time (22.2 versus 9.6{\%}; P = 0.036). In spite of high prematurity rates, no neonatal deaths occurred after 2000. The results in kidney transplant patients are significantly different from controls both considering all cases [preterm delivery: 57.3 versus 6.3{\%}; early preterm: 22.2 versus 0.9{\%}; small for gestational age (SGA): 14 versus 4.5{\%}; P < 0.001] and considering only transplant patients with normal kidney function [preterm delivery: 35 versus 6.3{\%}; early preterm: 10 versus 0.9{\%}; SGA: 23.7 versus 4.5{\%} (P < 0.001); risks increase across CKD stages]. Kidney function remained stable in most of the patients up to 6 months after delivery. Multiple regression analysis performed on the transplant cohort highlights a higher risk of preterm delivery in later CKD stages, an increase in preterm delivery and a decrease in SGA across periods. ConclusionsPregnancy after transplantation has a higher risk of adverse outcomes compared with the general population. Over time, the incidence of SGA babies decreased while the incidence of 'early preterm' babies increased. Although acknowledging the differences in therapy (cyclosporine versus tacrolimus) and in maternal age (significantly increased), the decrease in SGA and the increase in prematurity may be explained by an obstetric policy favouring earlier delivery against the risk of foetal growth restriction.",
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 = "2016",
month = "11",
day = "1",
doi = "10.1093/ndt/gfw232",
language = "English",
volume = "31",
pages = "1957--1965",
journal = "Nephrology Dialysis Transplantation",
issn = "0931-0509",
publisher = "Oxford University Press",
number = "11",

}

TY - JOUR

T1 - Pregnancy outcomes after kidney graft in Italy

T2 - Are the changes over time the result of different therapies or of different policies? A nationwide survey (1978-2013)

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 - 2016/11/1

Y1 - 2016/11/1

N2 - BackgroundKidney transplantation is the treatment of choice to restore fertility to women on renal replacement therapy. Over time, immunosuppressive, support therapies and approaches towards high-risk pregnancies have changed. The aim of this study was to analyse maternal-foetal outcomes in two cohorts of transplanted women who delivered a live-born baby in Italy in 1978-2013, dichotomized into delivery before and after January 2000. MethodsA survey involving all the Italian transplant centres was carried out, gathering data on all pregnancies recorded since the start of activity at each centre; the estimated nationwide coverage was 75%. Data on cause of ESRD, dialysis, living/cadaveric transplantation, drug therapy, comorbidity, and the main maternal-foetal outcomes were recorded and reviewed. Data were compared with a low-risk cohort of pregnancies from two large Italian centres (2000-14; Torino and Cagliari Observational Study cohort). ResultsThe database consists of 222 pregnancies with live-born babies after transplantation (83 before 2000 and 139 in 2000-13; 68 and 121 with baseline and birth data, respectively), and 1418 low-risk controls. The age of the patients significantly increased over time (1978-99: age 30.7 ± 3.7 versus 34.1 ± 3.7 in 2000-13; P < 0.001). Azathioprine, steroids and cyclosporine A were the main drugs employed in the first time period, while tacrolimus emerged in the second. The prevalence of early preterm babies increased from 13.4% in the first to 27.1% in the second period (P = 0.049), while late-preterm babies non-significantly decreased (38.8 versus 33.1%), thus leaving the prevalence of all preterm babies almost unchanged (52.2 and 60.2%; P = 0.372). Babies below the 5th percentile decreased over time (22.2 versus 9.6%; P = 0.036). In spite of high prematurity rates, no neonatal deaths occurred after 2000. The results in kidney transplant patients are significantly different from controls both considering all cases [preterm delivery: 57.3 versus 6.3%; early preterm: 22.2 versus 0.9%; small for gestational age (SGA): 14 versus 4.5%; P < 0.001] and considering only transplant patients with normal kidney function [preterm delivery: 35 versus 6.3%; early preterm: 10 versus 0.9%; SGA: 23.7 versus 4.5% (P < 0.001); risks increase across CKD stages]. Kidney function remained stable in most of the patients up to 6 months after delivery. Multiple regression analysis performed on the transplant cohort highlights a higher risk of preterm delivery in later CKD stages, an increase in preterm delivery and a decrease in SGA across periods. ConclusionsPregnancy after transplantation has a higher risk of adverse outcomes compared with the general population. Over time, the incidence of SGA babies decreased while the incidence of 'early preterm' babies increased. Although acknowledging the differences in therapy (cyclosporine versus tacrolimus) and in maternal age (significantly increased), the decrease in SGA and the increase in prematurity may be explained by an obstetric policy favouring earlier delivery against the risk of foetal growth restriction.

AB - BackgroundKidney transplantation is the treatment of choice to restore fertility to women on renal replacement therapy. Over time, immunosuppressive, support therapies and approaches towards high-risk pregnancies have changed. The aim of this study was to analyse maternal-foetal outcomes in two cohorts of transplanted women who delivered a live-born baby in Italy in 1978-2013, dichotomized into delivery before and after January 2000. MethodsA survey involving all the Italian transplant centres was carried out, gathering data on all pregnancies recorded since the start of activity at each centre; the estimated nationwide coverage was 75%. Data on cause of ESRD, dialysis, living/cadaveric transplantation, drug therapy, comorbidity, and the main maternal-foetal outcomes were recorded and reviewed. Data were compared with a low-risk cohort of pregnancies from two large Italian centres (2000-14; Torino and Cagliari Observational Study cohort). ResultsThe database consists of 222 pregnancies with live-born babies after transplantation (83 before 2000 and 139 in 2000-13; 68 and 121 with baseline and birth data, respectively), and 1418 low-risk controls. The age of the patients significantly increased over time (1978-99: age 30.7 ± 3.7 versus 34.1 ± 3.7 in 2000-13; P < 0.001). Azathioprine, steroids and cyclosporine A were the main drugs employed in the first time period, while tacrolimus emerged in the second. The prevalence of early preterm babies increased from 13.4% in the first to 27.1% in the second period (P = 0.049), while late-preterm babies non-significantly decreased (38.8 versus 33.1%), thus leaving the prevalence of all preterm babies almost unchanged (52.2 and 60.2%; P = 0.372). Babies below the 5th percentile decreased over time (22.2 versus 9.6%; P = 0.036). In spite of high prematurity rates, no neonatal deaths occurred after 2000. The results in kidney transplant patients are significantly different from controls both considering all cases [preterm delivery: 57.3 versus 6.3%; early preterm: 22.2 versus 0.9%; small for gestational age (SGA): 14 versus 4.5%; P < 0.001] and considering only transplant patients with normal kidney function [preterm delivery: 35 versus 6.3%; early preterm: 10 versus 0.9%; SGA: 23.7 versus 4.5% (P < 0.001); risks increase across CKD stages]. Kidney function remained stable in most of the patients up to 6 months after delivery. Multiple regression analysis performed on the transplant cohort highlights a higher risk of preterm delivery in later CKD stages, an increase in preterm delivery and a decrease in SGA across periods. ConclusionsPregnancy after transplantation has a higher risk of adverse outcomes compared with the general population. Over time, the incidence of SGA babies decreased while the incidence of 'early preterm' babies increased. Although acknowledging the differences in therapy (cyclosporine versus tacrolimus) and in maternal age (significantly increased), the decrease in SGA and the increase in prematurity may be explained by an obstetric policy favouring earlier delivery against the risk of foetal growth restriction.

UR - http://www.scopus.com/inward/record.url?scp=84996520920&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84996520920&partnerID=8YFLogxK

U2 - 10.1093/ndt/gfw232

DO - 10.1093/ndt/gfw232

M3 - Article

VL - 31

SP - 1957

EP - 1965

JO - Nephrology Dialysis Transplantation

JF - Nephrology Dialysis Transplantation

SN - 0931-0509

IS - 11

ER -