Pregnancy outcomes and long-term patient and graft survival after kidney transplantation

ABSTRACT Introduction Kidney transplant is considered the method of choice in the treatment of end-stage chronic kidney disease, improving survival and quality of life, and often allowing the recovery of fertility among woman. Objective: This study aims to assess the outcomes of post-transplant pregnancy, newborn and patient graft survival, compared to a control group of transplanted women who weren’t pregnant. Methods A retrospective case-control study was conducted at the Kidney Transplant Service of Santa Casa de Misericórdia in Porto Alegre, among 1.253 female patients who underwent kidney transplantation and were of childbearing age between 1977 and 2016. They were compared to a control group matched for age, type of donor, date of transplant and immunological risk. Results 76 (6,1%) of the patients became pregnant, resulting in a total of 93 pregnancies. Compared to the control group, at 10 years after transplantation there was no significant difference in relation to graft loss (74% vs 66%, p=0.524), and the survival of pregnant patients was higher (97% vs 79%, p=0.018). We found that 40% pregnancies progressed to abortion, 30% of the deliveries were preterm, and 26% happened at term. Three pregnancies progressed to stillbirth. Of the 56 pregnancies that evolved, 23 (41%) resulted in pre-eclampsia, and one in eclampsia. Conclusion 6,1% of the women in the study became pregnant, and 56% of these pregnancies were successful. Compared to the control group, we found that those who got pregnant had similar graft survival outcomes and longer patient survival.