Pregnancy outcomes in a Dutch living kidney donation popu­lation. 


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M.C. van Buren, C.A.J. Oudmaijer, L. Maasdam, M. Tielen, M.G.H. Betjes, J. van de Wetering

Chair(s): dr. Marion J. Siebelink, programmamanager Transplantatie Centrum, UMC Groningen & dr. Raechel J. Toorop, transplantatiechirurg, UMC Utrecht

Thursday 10 march 2016

9:20 - 9:30h at Zaal 14

Categories: Parallelsessie (donatie)

Parallel session: Parallelsessie IX - Donatie en Allocatie

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Introduction: 
The majority of kidney transplantations in the Netherlands are performed with a kidney from a living donor. Some of the female donors might have a future pregnancy wish. For these women it is of great importance to know if donating a kidney could have a possible negative effect on their future pregnancies. Literature is sparse on this subject. Although recent studies show a significant increase in the risk of pre-eclampsia, older studies did not show this increased risk.

The aim of this study was to investigate if a kidney donation affects complications in pregnancies.

Methods:
We conducted a single center retrospective study of living kidney donors between 1981 and July 2013. Women aged 45 years or younger at time of donation were interviewed about their pregnancies before and after kidney donation. First by telephone or at our outpatient clinic, when this was not possible we send them a questionnaire by email or post. Women who had been pregnant before donation were used as control group.

Results:
1462 living kidney donors donated their kidney at our hospital between 1981 and July 2013. We could include 172/259 (66%) women in our study, 5 died, 11 refused, 28 moved to foreign country or had no correct address and 43 could not be reached. Median age at donation was 38 yrs (18 - 45). 110/172 (68%) women had 292 pregnancies before donation at a median age at delivery of 27 yrs, compared to 25/172 (15%) women whom had 46 pregnancies after donation and median age at delivery of 33 yrs (p = 0.00). 37/172 (22%) had not been pregnant at all. Before donation women reported 38/292 (13%) miscarriages compared to 14/46 (30%) after donation (p = 0.01) and 11/292 (4%) abortions pre-donation compared to 1 (2%) post-donation (p = 1.00). Hypertension was reported in 19/243 (8%) of pre-donation pregnancies compared to 11/31 (35%) pregnancies after donation (p = 0.00). Pre-eclampsia before donation occurred in 4/243 (2%) of the pregnancies compared to 3/31 (10%) in post donation pregnancies (p = 0.03). HELLP syndrome was experienced in 2 pregnancies before donation (0,2%) compared to 1 (3%) in a post donation pregnancy (p = 0.30).

Discussion: 
Pregnancies after kidney donation are significantly more complicated by hypertension and pre-eclampsia as compared to the pregnancies before donation. Difference in age at delivery as well as the kidney donation may contribute to this finding. Further investigations are needed to confirm these outcomes.