Department of Organ Transplant Medicine, Tokyo Women's Medical University, Shinjuku, Japan.
Department of Urology, Tokyo Women's Medical University, Shinjuku, Japan.
Transpl Int. 2023 May 4;36:11220. doi: 10.3389/ti.2023.11220. eCollection 2023.
Pregnancy in kidney transplantation (KT) recipients has been challenging because of the high risk of maternal, fetal, and renal complications. Although patients with immunoglobulin A nephropathy (IgAN)-chronic kidney disease (CKD) are at a high risk for hypertension in pregnancy (HIP), the maternal risk in KT recipients with IgAN as the etiology remains unclear. We retrospectively reviewed the medical records of pregnant KT recipients who delivered at our hospital. The incidence of maternal and fetal complications and the impact on kidney allografts between the group with IgAN as the primary kidney disease and the group with other primary diseases were compared. The analysis included 73 pregnancies in 64 KT recipients. The IgAN group had a higher incidence of HIP than the non-IgAN group (69% vs. 40%, = 0.02). IgAN as primary kidney disease and interval from transplantation to conception were associated with HIP (OR 3.33 [1.11-9.92], = 0.03, OR 0.83 [0.72-0.96], < 0.01, respectively). The 20-year graft survival or prevention of CKD stage 5 in group with IgAN was lower than that in the group with other primary disease ( < 0.01). KT recipients should be informed of the risk of HIP and possibility of long-term worsening of postpartum renal function.
肾移植（KT）受者妊娠一直具有挑战性，因为存在母婴、胎儿和肾脏并发症的高风险。尽管免疫球蛋白 A 肾病（IgAN）-慢性肾脏病（CKD）患者在妊娠期间高血压（HIP）的风险较高，但病因是 IgAN 的 KT 受者的母婴风险仍不清楚。我们回顾性地审查了在我院分娩的妊娠 KT 受者的病历。比较了以 IgAN 为主要肾病的组和以其他原发性疾病为主要肾病的组之间母婴并发症的发生率和对肾移植物的影响。该分析包括 64 例 KT 受者的 73 次妊娠。IgAN 组 HIP 的发生率高于非 IgAN 组（69%比 40%， = 0.02）。以 IgAN 为主要肾病和从移植到受孕的时间间隔与 HIP 相关（OR 3.33[1.11-9.92]， = 0.03，OR 0.83[0.72-0.96]， < 0.01）。IgAN 组的 20 年移植物存活率或预防 CKD 第 5 期的情况低于其他原发性疾病组（ < 0.01）。应该告知 KT 受者 HIP 的风险和产后肾功能长期恶化的可能性。
