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https://hdl.handle.net/2440/110920
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Type: | Journal article |
Title: | Pregnancy outcomes and impact of pregnancy on graft function in women after kidney transplantation |
Author: | Mohammadi, F. Borg, M. Gulyani, A. McDonald, S. Jesudason, S. |
Citation: | Clinical Transplantation, 2017; 31(10) |
Publisher: | Wiley |
Issue Date: | 2017 |
ISSN: | 0902-0063 1399-0012 |
Statement of Responsibility: | F.A. Mohammadi, M. Borg, A. Gulyani, S.P. McDonald, S. Jesudason |
Abstract: | Background: Kidney transplantation facilitates pregnancy in women with end-stage kidney disease; however, the impact of pregnancy on short and longer-term graft function is uncertain. Methods: Obstetric, fetal, and graft outcomes for pregnancies from a large Australian transplant unit (1976-2015) were reviewed. Results: There were 56 pregnancies in 35 women with mean age at conception 30.4 ± 0.6 years and mean transplant-pregnancy interval 5.5 ± 0.5 years. The live birth rate was 78.9%. Preterm birth (<37 weeks) occurred in 56.5%. Hypertensive disorders affected 76% of women (pre-eclampsia in 30%). Median prepregnancy serum creatinine (SCr) was 100 μmol/L (interquartile range (IQR), 80, 114 μmol/L). One-third had deterioration in graft dysfunction during pregnancy; of these, 63.2% did not return to baseline. At 2 years post-partum, median SCr was 96.4 μmol/L (IQR, 81.5-124.3). Women with prepregnancy SCr > 110 μmol/L had increased risk of pre-eclampsia (OR 4.4; 95% CI 1.2-16.8; P = .03), but not preterm birth (OR 5.4; 95% CI 0.5-53; P = .04) or low birth-weight babies (OR 1.2; 95% CI 0.5-2.9; P = .04). Women with SCr > 140 μmol/L preconception had worst SCr trajectory, including higher rates of graft loss. Conclusions: Kidney transplantation pregnancies remain at high risk of obstetric complications, particularly pre-eclampsia. Prepregnancy graft function can be used to predict risk of adverse pregnancy outcomes and deterioration in graft function during and after delivery. |
Keywords: | Creatinine; kidney; pregnancy; tacrolimus; transplantation |
Rights: | © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd |
DOI: | 10.1111/ctr.13089 |
Grant ID: | http://purl.org/au-research/grants/nhmrc/1092957 |
Published version: | http://dx.doi.org/10.1111/ctr.13089 |
Appears in Collections: | Aurora harvest 8 Medicine publications |
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