Influence of pregnancy on eGFR slope in kidney transplant recipients

M.C. van Buren, M. Gosselink, H.W. van Hamersvelt, H. Groen, M.F.C. de Jong, A.T. Lely, J. van de Wetering

Wednesday 4 march 2020

17:10 - 17:20h at Joep Nicolas zaal

Parallel session: Parallel sessie VII – Basale- en Klinische abstracts

Background: Pregnancy after kidney transplantation (KT) is increasing during the last decades. Generally, pregnancy outcomes after KT are good. However, there is a higher risk of gestational hypertension, preeclampsia and dysmaturity compared with the general population. Less is known about the effect of pregnancy on kidney transplant function. For counselling prior to pregnancy, it is important to know the effect of pregnancy on eGFR slope.

Methods: We conducted a nationwide retrospective multi-center cohort study in women with a pregnancy (>20 weeks) after KT in the Netherlands from 1960 to 2017. Data on transplantation, kidney function and pregnancy were collected from health records. Changes in eGFR slope before and after pregnancy were analysed using individual pre-conception eGFR and post pregnancy eGFR values in a multilevel analysis performed by GEE.

Results: For this eGFR slope analysis we could include 197 women, with 3228 eGFR measurements. 109 (55%) with one 78 (40%) with 2 and 10 (5%) with 3 pregnancies after KT. Mean preconceptional eGFR was 62 ml/min (±21) at the first, 55 ml/min (±26) at the second and 51 ml/min (±25) at the third pregnancy. Overall the eGFR slope between pregnancies was not significantly different than the slope before the first pregnancy (p = 0.31). Subanalysis of women who only had one pregnancy did show a significant decline in eGFR slope after pregnancy (p = 0.01) Preconceptional eGFR (p = 0.00) and birthweight (p = 0.01) are the first identified predictors for a faster decline in eGFR after first pregnancy.

Conclusions: In the overall analysis eGFR slope is not affected by pregnancy in KT women. Women with only one pregnancy showed a faster decline of eGFR after pregnancy. Worse fetal outcome expressed in birthweight and worse preconceptional eGFR are riskfactors for a faster decline of eGFR after pregnancy.