Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN.
Division of Transplantation, Department of Surgery, University of Alabama at Birmingham, Birmingham, AL.
Transplantation. 2022 Oct 1;106(10):2052-2062. doi: 10.1097/TP.0000000000004146. Epub 2022 Apr 11.
Hypertension and diabetes are contraindications for living kidney donation in young candidates. However, little is known about the long-term outcomes of women who had these pregnancy-related complications and subsequently became donors. In the general population, gestational hypertension (GHtn), preeclampsia/eclampsia, and gestational diabetes (GDM) are associated with long-term risks.
Donors with the specified predonation complication were matched to contemporary control donors with pregnancies without the complication using nearest neighbor propensity score matching. Propensity scores were estimated using logistic regression with covariates for gravidity, blood pressure, glucose, body mass index, age, and creatinine at donation, donation year, race, relationship with recipient, and family history of disease. Long-term incidence of hypertension, diabetes, cardiovascular disease, and reduced renal function (estimated glomerular filtration rate [eGFR] <30, eGFR <45 mL/min/1.73 m 2 ) were compared between groups using proportional hazards models.
Of 1862 donors with predonation pregnancies, 48 had preeclampsia/eclampsia, 49 had GHtn without preeclampsia, and 43 had GDM. Donors had a long interval between first pregnancy and donation (median, 18.5 y; interquartile range, 10.6-27.5) and a long postdonation follow-up time (median, 18.0; interquartile range, 9.2-27.7 y). GHtn was associated with the development of hypertension (hazard ratio, 1.89; 95% confidence interval, 1.26-2.83); GDM was associated with diabetes (hazard ratio, 3.04; 95% confidence interval, 1.33-6.99). Pregnancy complications were not associated with eGFR <30 or eGFR <45 mL/min/1.73 m 2 .
Our data suggest that women with predonation pregnancy-related complications have long-term risks even with a normal donor evaluation. Donor candidates with a history of pregnancy-related complications should be counseled about these risks.
高血压和糖尿病是年轻供体进行活体肾脏捐献的禁忌症。然而，对于曾患有这些妊娠相关并发症并随后成为供体的女性，人们对其长期结局知之甚少。在一般人群中，妊娠期高血压 (GHtn)、子痫前期/子痫和妊娠期糖尿病 (GDM) 与长期风险相关。
通过最近邻倾向评分匹配，将有指定产前并发症的供体与妊娠无并发症的当代对照供体相匹配。使用逻辑回归和协变量来估计倾向得分，协变量包括生育次数、血压、血糖、体重指数、年龄、捐献时的肌酐、捐献年份、种族、与受者的关系以及疾病家族史。使用比例风险模型比较两组之间高血压、糖尿病、心血管疾病和肾功能下降（估计肾小球滤过率[eGFR] <30、eGFR <45 mL/min/1.73 m 2 ）的长期发生率。
在 1862 名有产前妊娠的供体中，48 名患有子痫前期/子痫，49 名患有无子痫前期的 GHtn，43 名患有 GDM。供体首次妊娠与捐献之间的间隔时间较长（中位数为 18.5 年；四分位距，10.6-27.5），且随访时间较长（中位数为 18.0 年；四分位距，9.2-27.7 年）。GHtn 与高血压的发生相关（风险比，1.89；95%置信区间，1.26-2.83）；GDM 与糖尿病相关（风险比，3.04；95%置信区间，1.33-6.99）。妊娠并发症与 eGFR <30 或 eGFR <45 mL/min/1.73 m 2 无关。
我们的数据表明，即使供体评估正常，曾患有产前妊娠相关并发症的女性也存在长期风险。有妊娠相关并发症病史的供体候选者应接受这些风险的咨询。
