Zhang Yan, Zhang Lily, Xia Weicong, Fang Lulu, Zhu Tongwei
Department of Nursing, Zhejiang University School of Medicine First Affiliated Hospital, No. 1367, Wenyi West Road, Yuhang District, Hangzhou City, 311100, Zhejiang Province, People's Republic of China.
Department of Cardiology, Zhejiang University School of Medicine First Affiliated Hospital, No. 1367, Wenyi West Road, Yuhang District, Hangzhou City, 311100, Zhejiang Province, People's Republic of China.
Arch Gynecol Obstet. 2025 May;311(5):1305-1313. doi: 10.1007/s00404-025-07947-2. Epub 2025 Feb 5.
To investigate the effect of postoperative pregnancy on maternal-infant outcomes and transplanted kidney function in kidney transplantation (KT) recipients.
Our study included 104 KT recipients and 104 non-KT women who delivered at four hospitals affiliated with Zhejiang University School of Medicine from December 2015 to November 2023.
In the KT group, kidney function showed a downward trend after delivery, and most patients recovered normal kidney function within 6 months postpartum. Tacrolimus blood concentration during pregnancy averaged (6.1 ± 1.4) μg/L, increasing to (7.1 ± 2.6) μg/L on the second day after delivery, indicating an upward trend in postpartum concentrations. Compared to the non-KT group, the KT group had higher prevalences of gestational hypertension (33.7% vs. 3.3%), gestational diabetes mellitus (21.2% vs. 17.5%), intrahepatic cholestasis of pregnancy (5.8% vs. 1.7%), placental abruption (1.9% vs. 0.8%), and preterm birth rate (79.8% vs. 9.2%) but had a lower prevalence of fetal growth restriction (8.3% vs. 21.7%). Univariate analysis showed that pre-pregnancy estimated glomerular filtration rate (eGFR), penatal eGFR, gestational hypertension, and preeclampsia may influence neonatal outcomes. Binary logistic regression analysis showed that preeclampsia (odds ratio [OR] = 133.89, 95% confidence interval [CI]: 1.27-156.20, P = 0.031) and hypertension during pregnancy (OR = 5.81, 95% CI: 1.02-33.27, P = 0.048) were risk factors, and glomerular filtration rate during pregnancy (OR = 0.95, 95% CI: 0.90-0.99, P = 0.026) was a protective factor.
Although pregnancies in KT recipients are considered high-risk, the overall risks are manageable. Strengthening the management of KT recipients with reproductive intent is recommended to improve maternal and infant outcomes.
探讨肾移植（KT）受者术后妊娠对母婴结局及移植肾功能的影响。
我们的研究纳入了2015年12月至2023年11月在浙江大学医学院附属四家医院分娩的104例KT受者和104例非KT女性。
在KT组中，产后肾功能呈下降趋势，大多数患者在产后6个月内肾功能恢复正常。孕期他克莫司血药浓度平均为（6.1±1.4）μg/L，产后第二天升至（7.1±2.6）μg/L，表明产后浓度呈上升趋势。与非KT组相比，KT组妊娠期高血压（33.7%对3.3%）、妊娠期糖尿病（21.2%对17.5%）、妊娠期肝内胆汁淤积症（5.8%对1.7%）、胎盘早剥（1.9%对0.8%）和早产率（79.8%对9.2%）的患病率更高，但胎儿生长受限的患病率较低（8.3%对21.7%）。单因素分析显示，孕前估计肾小球滤过率（eGFR）、产前eGFR、妊娠期高血压和子痫前期可能影响新生儿结局。二元逻辑回归分析显示，子痫前期（比值比[OR]=133.89，95%置信区间[CI]：1.27-156.20，P=0.031）和孕期高血压（OR=5.81，95%CI：1.02-33.27，P=0.048）是危险因素，孕期肾小球滤过率（OR=0.95，95%CI：0.90-0.99，P=0.026）是保护因素。
尽管KT受者妊娠被认为是高危妊娠，但总体风险是可控的。建议加强对有生育意愿的KT受者的管理，以改善母婴结局。
