Mohammadi F A, Borg M, Gulyani A, McDonald S P, Jesudason S
Central and Northern Adelaide Renal and Transplantation Services (CNARTS), Adelaide, SA, Australia.
Department of Medicine, University of Adelaide, Adelaide, SA, Australia.
Clin Transplant. 2017 Oct;31(10). doi: 10.1111/ctr.13089. Epub 2017 Sep 7.
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.
Obstetric, fetal, and graft outcomes for pregnancies from a large Australian transplant unit (1976-2015) were reviewed.
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.
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.
肾移植有助于终末期肾病女性怀孕；然而，怀孕对短期和长期移植肾功能的影响尚不确定。
回顾了澳大利亚一个大型移植单位（1976 - 2015年）妊娠的产科、胎儿和移植结局。
35名女性中有56次妊娠，平均受孕年龄30.4±0.6岁，平均移植 - 妊娠间隔5.5±0.5年。活产率为78.9%。早产（<37周）发生率为56.5%。高血压疾病影响76%的女性（子痫前期占30%）。妊娠前血清肌酐（SCr）中位数为100μmol/L（四分位间距（IQR），80，114μmol/L）。三分之一的患者在孕期移植肾功能恶化；其中，63.2%未恢复至基线水平。产后2年，SCr中位数为96.4μmol/L（IQR，81.5 - 124.3）。妊娠前SCr>110μmol/L的女性患子痫前期的风险增加（OR 4.4；95%CI 1.2 - 16.8；P = 0.03），但早产风险未增加（OR 5.4；95%CI 0.5 - 53；P = 0.04），低体重儿风险也未增加（OR 1.2；95%CI 0.5 - 2.9；P = 0.04）。妊娠前SCr>140μmol/L的女性SCr变化轨迹最差，包括移植肾丢失率更高。
肾移植后妊娠仍有较高的产科并发症风险，尤其是子痫前期。妊娠前移植肾功能可用于预测不良妊娠结局以及分娩期间和产后移植肾功能恶化的风险。
