PRE-ECLAMPSIA IN PREGNANCIES AFTER KIDNEY TRANSPLANTATION (KT): DETERMINANTS AND IMPACT ON PREGNANCY AND GRAFT OUTCOMES

S JESUDASON1, 3, A GULYANI2, P CLAYTON1,2, 3, M WYLD4,5, S MCDONALD1,2,3

1Central and Northern Adelaide Renal and Transplantation Service (CNARTS), Royal Adelaide Hospital, Adelaide SA; 2ANZDATA Registry, SA Health and Medical Research Institute, Adelaide, SA; 3University of Adelaide, Adelaide, SA; 4University of Sydney, Sydney, NSW, 5Royal Prince Alfred Hospital, Sydney, NSW

Aim: To explore determinants and impact of pre-eclampsia post-KT.

Background: Transplanted women have high rates of pre-eclampsia, however drivers of this remain unclear.

Methods: We analysed pregnancies >20 weeks duration in women with KT reported to ANZDATA (2000-14).

Results: Pre-eclampsia (Yes/No) was available for 275 of 291 pregnancies; 90 women (33%) reported pre-eclampsia. These women had higher median pre-conception serum creatinine (SCr; 114 μmol/L, IQR 91,131 vs. 103 μmol/L, IQR 90,120; p=0.027), lower median MDRD eGFR (51.8 vs. 56.9 ml/min; p=0.028) and more likely to have preconception SCr >110 μmol/L (OR 1.9, 95% CI 1.15-3.20; p =0.012). In multivariate analysis of maternal factors (age, BMI, primary renal disease, transplant-pregnancy interval, SCr >110 μmol/L) only SCr >110 μmol/L was associated with increased risk of pre-eclampsia (OR 1.94, 95% CI 1.11-3.40).

The live birth rate was similar in women with and without pre-eclampsia (96.7% vs. 97.3%, p=0.77). Pre-eclampsia was associated with higher risk of preterm birth (<37 weeks vs. ≥37weeks, OR 3.16, 95%CI 1.81-5.52) and low birthweight (<2500gm vs. ≥2500gm, OR 3.57, 95%CI 2.03, 6.28).

Mean maternal follow-up was 6.0±4.4 years, with 46 graft failures identified. Similar graft survival between pre-eclampsia / no pre-eclampsia groups (log-rank test, p=0.19). In a Cox-regression model, pre-eclampsia did not confer increased risk of graft failure (HR 1.5, 95% CI 0.46-5.11; p=0.48) whereas preconception creatinine >110 μmol/L was associated with graft loss (HR 3.2, 95% CI 1.4-7.3; p=0.005).

Conclusions: Higher pre-conception SCr is associated with increased risk of pre-eclampsia after pregnancy. Pre-eclampsia is associated with worse fetal outcomes, but not with fetal loss or poorer graft survival. Transplanted women should receive tailored pre-conception counselling.

About ANZSN

The ASM is hosted by Australian and New Zealand Society of Nephrology.

The aims of the Society are to promote and support the study of the kidney and urinary tract in health and disease, and to ensure the highest professional standards for the practice of nephrology in Australia and New Zealand.

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