Erasmus MC Transplant Institute, Department of Internal Medicine, University Medical Center, Rotterdam, The Netherlands.
Department of Obstetrics, Wilhelmina Children's Hospital Birth Center, University Medical Center Utrecht, Utrecht, The Netherlands.
Transplantation. 2022 Jun 1;106(6):1262-1270. doi: 10.1097/TP.0000000000003932. Epub 2022 Aug 27.
The effect of pregnancy on the course of estimated glomerular filtration rate (eGFR) is unknown in kidney transplant recipients (KTRs).
We conducted a nationwide multicenter cohort study in KTRs with pregnancy (>20 wk) after kidney transplantation (KT). Annual eGFRs after KT until death or graft loss and additional eGFRs before each pregnancy were collected according to protocol. Changes in eGFR slope before and after each pregnancy were analyzed by generalized estimating equations multilevel analysis adjusted for transplant vintage.
We included 3194 eGFR measurements before and after pregnancy in 109 (55%) KTRs with 1, 78 (40%) with 2, and 10 (5%) with 3 pregnancies after KT. Median follow-up after first delivery post-KT was 14 y (interquartile range, 18 y). Adjusted mean eGFR prepregnancy was 59 mL/min/1.73 m2 (SEM [standard error of the mean] 1.72; 95% confidence interval [CI], 56-63), after the first pregnancy 56 mL/min/1.73 m2 (SEM 1.70; 95% CI, 53-60), after the second pregnancy 56 mL/min/1.73 m2 (SEM 2.19; 95% CI, 51-60), and after the third pregnancy 55 mL/min/1.73 m2 (SEM 8.63; 95% CI, 38-72). Overall eGFR slope after the first, second, and third pregnancies was not significantly worse than prepregnancy (P = 0.28). However, adjusted mean eGFR after the first pregnancy was 2.8 mL/min/1.73 m2 (P = 0.08) lower than prepregnancy.
The first pregnancy has a small, but insignificant, effect on eGFR slope in KTRs. Midterm hyperfiltration, a marker for renal reserve capacity, was associated with better eGFR and death-censored graft survival. In this KTR cohort with long-term follow-up, no significant effect of pregnancy on kidney function was detected.
妊娠对肾移植受者（KTR）估算肾小球滤过率（eGFR）病程的影响尚不清楚。
我们在肾移植后（KT）妊娠（>20 周）的 KTR 中进行了一项全国多中心队列研究。根据方案收集了 KT 后直至死亡或移植物丢失前的年度 eGFR 以及每次妊娠前的额外 eGFR。通过广义估计方程多层次分析，调整移植年代因素，分析每次妊娠前后 eGFR 斜率的变化。
我们纳入了 109 例（55%）KTR 中有 1 次、78 例（40%）有 2 次和 10 例（5%）有 3 次妊娠的 3194 次 eGFR 测量值。首次产后 KT 后中位随访时间为 14 年（四分位距，18 年）。调整后的孕前 eGFR 均值为 59 mL/min/1.73 m2（SEM [均值的标准误差] 1.72；95%可信区间 [CI]，56-63），第一次妊娠后为 56 mL/min/1.73 m2（SEM 1.70；95% CI，53-60），第二次妊娠后为 56 mL/min/1.73 m2（SEM 2.19；95% CI，51-60），第三次妊娠后为 55 mL/min/1.73 m2（SEM 8.63；95% CI，38-72）。首次、第二次和第三次妊娠后的总体 eGFR 斜率均无明显低于孕前（P=0.28）。然而，第一次妊娠后的调整后 eGFR 均值比孕前低 2.8 mL/min/1.73 m2（P=0.08）。
第一次妊娠对 KTR 的 eGFR 斜率有轻微但无统计学意义的影响。中期高滤过，即肾功能储备能力的标志物，与更好的 eGFR 和死亡无移植相关的移植物存活率相关。在这项具有长期随访的 KTR 队列中，未发现妊娠对肾功能有显著影响。
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