Pregnancy outcomes in kidney transplant recipients: A systematic review and meta-analysis

N. A. Deshpande, N. T. James, L. M. Kucirka, B. J. Boyarsky, J. M. Garonzik-Wang, R. A. Montgomery, D. L. Segev

Research output: Contribution to journalReview article

Abstract

Approximately 50 000 women of reproductive age in theUnited States are currently living after kidney transplantation (KT), and another 2800 undergo KT each year. Although KT improves reproductive function in women with ESRD, studies of post-KT pregnancies are limited to a few voluntary registry analyses and numerous single-center reports. To obtain more generalizable inferences, we performed a systematic review and meta-analysis of articles published between 2000 and 2010 that reported pregnancy-related outcomes among KT recipients. Of 1343 unique studies, 50 met inclusion criteria, representing 4706 pregnancies in 3570 KT recipients. The overall post-KT live birth rate of 73.5% (95%CI 72.1-74.9) was higher than the general US population (66.7%); similarly, the overall post-KT miscarriage rate of 14.0% (95%CI 12.9- 15.1) was lower (17.1%). However, complications of preeclampsia (27.0%, 95%CI 25.2-28.9), gestational diabetes (8.0%, 95%CI 6.7-9.4), Cesarean section (56.9%, 95%CI 54.9-58.9) and preterm delivery (45.6%, 95%CI 43.7-47.5) were higher than the general US population (3.8%, 3.9%, 31.9% and 12.5%, respectively). Pregnancy outcomes were more favorable in studies with lower mean maternal ages; obstetrical complications were higher in studies with shorter mean interval between KT and pregnancy. Although post-KT pregnancy is feasible, complications are relatively high and should be considered in patient counseling and clinical decision making.

Original languageEnglish (US)
Pages (from-to)2388-2404
Number of pages17
JournalAmerican Journal of Transplantation
Volume11
Issue number11
DOIs
StatePublished - Nov 1 2011

Keywords

  • Kidney transplantation
  • Meta-analysis
  • Pregnancy after transplantation

ASJC Scopus subject areas

  • Immunology and Allergy
  • Transplantation
  • Pharmacology (medical)

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