Schaeffers, A. (Anouk) (2017) Influence of pregnancy on long-term kidney function in renal transplant recipients. thesis, Medicine.
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Abstract
Kidney transplantation (KT) is recommended for patients with end-stage kidney disease (ESKD) and one of the potential benefits is restored fertility. However, pregnancy after KT carries extra maternal and fetal risks. Only few studies have been done towards the effect of pregnancy on long-term graft function and previous results have been contradicting. Method: In this retrospective multi-center cohort study, the effect of pregnancy on the slope of serum creatinine (SCr) is studied. Maternal and graft characteristics, pregnancy outcomes and renal function measurements were extracted from patient records, after identifying all women who got pregnant after KT. Results: For 76 at least one pregnancy was registered. In 90% of these women, at least one pregnancy (> 20 weeks of gestation) resulted in live birth. 24 patients lost their graft during follow-up (32%). The median deterioration prior to pregnancy, defined as increase in SCr, was 0.0 μmol/L/year. After pregnancy the deterioration was 1.0 μmol/L/year, which was significantly different (p < 0.001). We did find a significant difference in the change of slopes when a sub analysis was done towards having or not having proteinuria prior to pregnancy. No other significant pre pregnancy determinants for increased deterioration were found. We did find higher incidences of adverse pregnancy outcomes when comparing women with SCr ≥ 132 μmol/L to women with lower SCr prior to pregnancy. Conclusion: Pregnancy might influence long-term graft function, since the slope of increase in SCr was steeper after pregnancy than prior to pregnancy. Proteinuria was an important predictor for accelerated decline in renal function, which is in line with previous studies that have been used as foundation for current international guidelines regarding pregnancy counselling after KT. However, a high SCr did not lead to adverse renal outcomes in our study. The current database needs to be expanded, so a more reliable conclusion can be drawn.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Navis, Prof. Dr. G.J. and (University Medical Center Groningen, department of Nephrolo |
| Supervisor name: | Lely Dr. A.T. (University Medical Center Utrecht, departmen and Paauw, Drs. N.D.PhD student (University Medical Center Utrec |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:41 |
| Last Modified: | 25 Jun 2020 10:41 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/233 |
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