Kaatz Rebecca, Latartara Elisabetta, Bachmann Friederike, Lachmann Nils, Koch Nadine, Zukunft Bianca, Wu Kaiyin, Schmidt Danilo, Halleck Fabian, Nickel Peter, Eckardt Kai-Uwe, Budde Klemens, Verlohren Stefan, Choi Mira
Department of Nephrology and Medical Intensive Care, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 13353 Berlin, Germany.
Department of Obstetrics, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 13353 Berlin, Germany.
J Clin Med. 2023 Feb 15;12(4):1545. doi: 10.3390/jcm12041545.
Women of childbearing age show increased fertility after kidney transplantation. Of concern, preeclampsia, preterm delivery, and allograft dysfunction contribute to maternal and perinatal morbidity and mortality. We performed a retrospective single-center study, including 40 women with post-transplant pregnancies after single or combined pancreas-kidney transplantation between 2003 and 2019. Outcomes of kidney function up to 24 months after the end of pregnancy were compared with a matched-pair cohort of 40 transplanted patients without pregnancies. With a maternal survival rate of 100%, 39 out of 46 pregnancies ended up with a live-born baby. The eGFR slopes to the end of 24 months follow-up showed mean eGFR declines in both groups (-5.4 ± 14.3 mL/min in pregnant versus -7.6 ± 14.1 mL/min in controls). We identified 18 women with adverse pregnancy events, defined as preeclampsia with severe end-organ dysfunction. An impaired hyperfiltration during pregnancy was a significant risk contributor for both adverse pregnancy events ( < 0.05) and deterioration of kidney function ( < 0.01). In addition, a declining renal allograft function in the year before pregnancy was a negative predictor of worsening allograft function after 24 months of follow-up. No increased frequency of de novo donor-specific antibodies after delivery could be detected. Overall, pregnancies in women after kidney transplantation showed good allograft and maternal outcomes.
育龄女性肾移植后生育能力增强。令人担忧的是，先兆子痫、早产和移植肾功能障碍会导致孕产妇和围产期发病及死亡。我们进行了一项回顾性单中心研究，纳入了2003年至2019年间40例单肾移植或胰肾联合移植后妊娠的女性。将妊娠结束后长达24个月的肾功能结果与40例未妊娠的匹配移植患者队列进行比较。孕产妇生存率为100%，46例妊娠中有39例以活产婴儿告终。至24个月随访结束时的估算肾小球滤过率（eGFR）斜率显示两组的eGFR均下降（妊娠组为-5.4±14.3 mL/分钟，对照组为-7.6±14.1 mL/分钟）。我们确定了18例发生不良妊娠事件的女性，不良妊娠事件定义为伴有严重终末器官功能障碍的先兆子痫。妊娠期间的高滤过受损是不良妊娠事件（<0.05）和肾功能恶化（<0.01）的重要风险因素。此外，妊娠前一年移植肾功能下降是随访24个月后移植肾功能恶化的负性预测指标。产后未检测到新生供者特异性抗体频率增加。总体而言，肾移植后女性的妊娠显示出良好的移植肾和孕产妇结局。
