Predictors for Adverse Pregnancy Outcomes in the Dutch Renal Transplant Population

M.E. Gosselink, M. van Buren, T.K.J. Groenhof, H. van Hamersvelt, J. van de Wetering, A.T. Lely

Thursday 15 march 2018

12:10 - 12:20h at Van Rijck/Ruys Zaal

Categories: Clinical, Session (parallel)

Parallel session: Parallel session 5: Clinical

Introduction

Pregnancy in renal transplants (RT) is increasing during the last decades. Generally, there are good pregnancy outcomes in RT. However, there is a high risk for maternal hypertension and fetal complications including pre- and dysmaturity. Higher level of preconceptional serum creatinine, proteinuria and hypertension are associated with adverse pregnancy outcomes (APO). A recent publication shows that mid-term eGFR shows a U-shaped relationship between eGFR and APO. The prognostic value of midterm serum creatinine (Scr) and blood pressure (BP) drop in RT patients is unknown. Therefore, all Dutch university medical centers collaborated in a new data network named ‘PARTOUT’ (Pregnancy After Renal Transplantation OUTcomes) and investigated the predictive factors for APO in RT patients.

Method

A retrospective nationwide multi-center cohort study was carried out in women with a first pregnancy (>20 weeks) after RT in the Netherlands from 1960 to 2017. Data on transplantation, pregnancy and pregnancy outcomes were collected from (electronic) health records. Midterm Scr was defined as the lowest Scr in 8-20 weeks of pregnancy. The relationship between midterm Scr, BP and APO was assessed using multivariate regression. A combined adverse outcome was defined as low birthweight (rd trimester (>170 systolic BP, >110 diastolic BP), 3^rd trimester Scr > preconceptional Scr.

Results

A total of 130 RT patients were included in the analysis. In 96 patients (76%) an APO occurred. Birthweight rd trimester Scr 42 (45%). In preliminary analysis higher levels of midterm Scr were associated with a higher risk of APO (98(28) vs 77(20) mmol/l p=0.001). On average, women with APO had no physiological BP drop in first trimester (p=0.002).

Conclusion

Besides known predictors for APO as preconceptional Scr our analysis shows a relationship between midterm Scr and blood pressure drop and adverse pregnancy outcomes. Both factors could be related to absence of renal vascular capacity to adapt to pregnancy. Future analysis of the PARTOUT and other RT dataset could investigate which other clinical parameters are the most useful in predicting adverse pregnancy and long-term RT function after pregnancy