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.

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