Kidney Research and Clinical Practice

Korean Society of Nephrology (대한신장학회)
권호 표지
DOI QR코드

DOI QR Code

Maternal and fetal outcomes of pregnancies in kidney donors: A 30-year comparative analysis of matched non-donors in a single center

  • Yoo, Kyung Don (Department of Internal Medicine, Dongguk University College of Medicine) ;
  • Lee, Hajeong (Department of Internal Medicine, Seoul National University College of Medicine) ;
  • Kim, Yaerim (Department of Internal Medicine, Seoul National University College of Medicine) ;
  • Park, Sehoon (Department of Internal Medicine, Seoul National University College of Medicine) ;
  • Park, Joong Shin (Department of Obstetrics and Gynecology, Seoul National University Hospital) ;
  • Hong, Joon Seok (Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital) ;
  • Jeong, Chang Wook (Department of Urology, Seoul National University College of Medicine) ;
  • Kim, Hyeon Hoe (Department of Urology, Seoul National University College of Medicine) ;
  • Lee, Jung Pyo (Department of Internal Medicine, SMG-SNU Boramae Medical Center) ;
  • Kim, Dong Ki (Department of Internal Medicine, Seoul National University College of Medicine) ;
  • Oh, Kook-Hwan (Department of Internal Medicine, Seoul National University College of Medicine) ;
  • Joo, Kwon Wook (Department of Internal Medicine, Seoul National University College of Medicine) ;
  • Kim, Yon Su (Department of Internal Medicine, Seoul National University College of Medicine)
  • Received : 2018.05.28
  • Accepted : 2018.10.05
  • Published : 2018.12.31
⟨ Previous Next ⟩

Abstract

Background: Woman kidney donors face obstetric complication risks after kidney donation, such as gestational hypertension and preeclampsia. Studies on childbirth-related complications among Asian women donors are scarce. Methods: This retrospective cohort study included woman donors aged 45 years or younger at the time of kidney donation in a single tertiary hospital between 1985 and 2014. Pregnancy associated complications were investigated using medical records and telephone questionnaires for 426 pregnancies among 225 donors. Matched non-donor controls were selected by propensity score and the maternal and fetal outcomes were compared with those of donors. Primary outcomes were differences in maternal complications, and secondary outcomes were fetal outcomes in pregnancies of the donor and control groups. Results: A total of 56 cases had post-donation pregnancies. The post-donation pregnancies group was younger at the time of donation and older at the time of delivery than the pre-donation pregnancies group, and there were no differences in primary outcomes between the groups except the proportion receiving cesarean section. Comparison of the complication risk between post-donation pregnancies and non-donor matched controls showed no significant differences in gestational hypertension, preeclampsia, or composite outcomes after propensity score matching including age at delivery, era at pregnancy, systolic blood pressure, body weight, and estimated glomerular filtration ratio (odds ratio, 0.63; 95% confidence interval, 0.19-2.14; P = 0.724). Conclusion: This study revealed that maternal and fetal outcomes between woman kidney donors and non-donor matched controls were comparable. Studies with general population pregnancy controls are warranted to compare pregnancy outcomes for donors.

Keywords

Acknowledgement

Supported by : Korea Health Industry Development Institute (KHIDI), Ministry of Science, ICT and Future Planning of Korea

References

  1. Wolfe RA, Ashby VB, Milford EL, et al. Comparison of mortality in all patients on dialysis, patients on dialysis awaiting transplantation, and recipients of a first cadaveric transplant. N Engl J Med 341:1725-1730, 1999 https://doi.org/10.1056/NEJM199912023412303
  2. Yoo KD, Kim CT, Kim MH, et al. Superior outcomes of kidney transplantation compared with dialysis: an optimal matched analysis of a national population-based cohort study between 2005 and 2008 in Korea. Medicine (Baltimore) 95:e4352, 2016 https://doi.org/10.1097/MD.0000000000004352
  3. Laupacis A, Keown P, Pus N, et al. A study of the quality of life and cost-utility of renal transplantation. Kidney Int 50:235-242, 1996 https://doi.org/10.1038/ki.1996.307
  4. Siminoff LA, Burant CJ, Ibrahim SA. Racial disparities in preferences and perceptions regarding organ donation. J Gen Intern Med 21:995-1000, 2006 https://doi.org/10.1007/BF02743151
  5. Grams ME, Sang Y, Levey AS, et al. Kidney-failure risk projection for the living kidney-donor candidate. N Engl J Med 374:411-421, 2016 https://doi.org/10.1056/NEJMoa1510491
  6. Garg AX, Nevis IF, McArthur E, et al. Gestational hypertension and preeclampsia in living kidney donors. N Engl J Med 372:124-133, 2015 https://doi.org/10.1056/NEJMoa1408932
  7. Park S, Yoo KD, Park JS, et al. Pregnancy in women with immunoglobulin A nephropathy: are obstetrical complications associated with renal prognosis? Nephrol Dial Transplant 33:459-465, 2018 https://doi.org/10.1093/ndt/gfx061
  8. Park S, Lee SM, Park JS, et al. Midterm eGFR and adverse pregnancy outcomes: the clinical significance of gestational hyperfiltration. Clin J Am Soc Nephrol 12:1048-1056, 2017 https://doi.org/10.2215/CJN.12101116
  9. Boudville N, Prasad GV, Knoll G, et al. Meta-analysis: risk for hypertension in living kidney donors. Ann Intern Med 145:185-196, 2006 https://doi.org/10.7326/0003-4819-145-3-200608010-00006
  10. Garg AX, Muirhead N, Knoll G, et al. Proteinuria and reduced kidney function in living kidney donors: a systematic review, meta-analysis, and meta-regression. Kidney Int 70:1801-1810, 2006 https://doi.org/10.1038/sj.ki.5001819
  11. Tangren JS, Powe CE, Ankers E, et al. Pregnancy outcomes after clinical recovery from AKI. J Am Soc Nephrol 28:1566-1574, 2017 https://doi.org/10.1681/ASN.2016070806
  12. Piccoli GB, Cabiddu G, Attini R, et al. Risk of adverse pregnancy outcomes in women with CKD. J Am Soc Nephrol 26:2011-2022, 2015 https://doi.org/10.1681/ASN.2014050459
  13. Reisaeter AV, Roislien J, Henriksen T, Irgens LM, Hartmann A. Pregnancy and birth after kidney donation: the Norwegian experience. Am J Transplant 9:820-824, 2009 https://doi.org/10.1111/j.1600-6143.2008.02427.x
  14. Ibrahim HN, Akkina SK, Leister E, et al. Pregnancy outcomes after kidney donation. Am J Transplant 9:825-834, 2009 https://doi.org/10.1111/j.1600-6143.2009.02548.x
  15. Bigelow CA, Pereira GA, Warmsley A, et al. Risk factors for new-onset late postpartum preeclampsia in women without a history of preeclampsia. Am J Obstet Gynecol 210:338.e1-338.e8, 2014 https://doi.org/10.1016/j.ajog.2013.11.004
  16. Sanchez OA, Ferrara LK, Rein S, Berglund D, Matas AJ, Ibrahim HN. Hypertension after kidney donation: incidence, predictors, and correlates. Am J Transplant 18:2534-2543, 2018 https://doi.org/10.1111/ajt.14713
  17. Austin PC. An introduction to propensity score methods for reducing the effects of confounding in observational studies. Multivariate Behav Res 46:399-424, 2011 https://doi.org/10.1080/00273171.2011.568786
  18. Matas AJ, Hays RE. Gender disparities and financial barriers to living kidney donation. J Am Soc Nephrol 29:1081-1083, 2018 https://doi.org/10.1681/ASN.2018020158
  19. Bloembergen WE, Port FK, Mauger EA, Briggs JP, Leichtman AB. Gender discrepancies in living related renal transplant donors and recipients. J Am Soc Nephrol 7:1139-1144, 1996
  20. LaPointe Rudow D, Hays R, Baliga P, et al. Consensus conference on best practices in live kidney donation: recommendations to optimize education, access, and care. Am J Transplant 15:914-922, 2015 https://doi.org/10.1111/ajt.13173
  21. Lentine KL, Kasiske BL, Levey AS, et al. KDIGO clinical practice guideline on the evaluation and care of living kidney donors. Transplantation 101(8S Suppl 1):S1-S109, 2017
  22. O'Keeffe LM, Ramond A, Oliver-Williams C, et al. Mid- and long-term health risks in living kidney donors: a systematic review and meta-analysis. Ann Intern Med 168:276-284, 2018 https://doi.org/10.7326/M17-1235
  23. Lentine KL, Schnitzler MA, Garg AX, et al. Race, relationship and renal diagnoses after living kidney donation. Transplantation 99:1723-1729, 2015 https://doi.org/10.1097/TP.0000000000000733
  24. Muzaale AD, Massie AB, Wang MC, et al. Risk of end-stage renal disease following live kidney donation. JAMA 311:579-586, 2014 https://doi.org/10.1001/jama.2013.285141
  25. Lentine KL, Segev DL. Health outcomes among non-Caucasian living kidney donors: knowns and unknowns. Transpl Int 26:853-864, 2013 https://doi.org/10.1111/tri.12088
  26. Mjoen G, Hallan S, Hartmann A, et al. Long-term risks for kidney donors. Kidney Int 86:162-167, 2014 https://doi.org/10.1038/ki.2013.460
  27. Maggiore U, Budde K, Heemann U, et al. Long-term risks of kidney living donation: review and position paper by the ERA-EDTA DESCARTES working group. Nephrol Dial Transplant 32:216-223, 2017 https://doi.org/10.1093/ndt/gfw429
  28. Garg AX, McArthur E, Lentine KL. Gestational hypertension and preeclampsia in living kidney donors. N Engl J Med 372:1469-1470, 2015
  29. Bryant AS, Worjoloh A, Caughey AB, Washington AE. Racial/ethnic disparities in obstetric outcomes and care: prevalence and determinants. Am J Obstet Gynecol 202:335-343, 2010 https://doi.org/10.1016/j.ajog.2009.10.864
  30. National Institute for Health and Care Excellence. Antenatal care for uncomplicated pregnancies. Available at : https://www.nice.org.uk/guidance/cg62 [Date accessed: 21 September 2018]