title: Timing of Pregnancy After Kidney Transplantation and Risk of Allograft Failure.
abstract: The optimal timing of pregnancy after kidney transplantation remains uncertain. We determined the risk of allograft failure among women who became pregnant within the first 3 posttransplant years. Among 21 814 women aged 15-45 years who received a first kidney-only transplant between 1990 and 2010 captured in the United States Renal Data System, n = 729 pregnancies were identified using Medicare claims. The probability of allograft failure from any cause including death (ACGL) at 1, 3, and 5 years after pregnancy was 9.6%, 25.9%, and 36.6%. In multivariate analyses, pregnancy in the first posttransplant year was associated with an increased risk of ACGL (hazard ratio [HR]: 1.18; 95% confidence interval [CI] 1.00, 1.40) and death censored graft loss (DCGL) (HR:1.25; 95% CI 1.04, 1.50), while pregnancy in the second posttransplant year was associated with an increased risk of DCGL (HR: 1.26; 95% CI 1.06, 1.50). Pregnancy in the third posttransplant year was not associated with an increased risk of ACGL or DCGL. These findings demonstrate a higher incidence of allograft failure after pregnancy than previously reported and that the increased risk of allograft failure extends to pregnancies in the second posttransplant year.
authors.affiliation: Division of Nephrology, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: C
authors.initials: C
authors.lastname: Rose
authors.affiliation: Division of Nephrology, University of British Columbia, Vancouver, British Columbia, Canada.|Centre for Health Evaluation and Outcomes Sciences, University of British Columbia, Vancouver, Canada.
authors.forename: J
authors.initials: J
authors.lastname: Gill
authors.affiliation: Division of Nephrology, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: N
authors.initials: N
authors.lastname: Zalunardo
authors.affiliation: Division of Nephrology, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: O
authors.initials: O
authors.lastname: Johnston
authors.affiliation: Division of Nephrology, Mount Sinai School of Medicine, New York, NY.
authors.forename: A
authors.initials: A
authors.lastname: Mehrotra
authors.affiliation: Division of Nephrology, University of British Columbia, Vancouver, British Columbia, Canada.|Centre for Health Evaluation and Outcomes Sciences, University of British Columbia, Vancouver, Canada.|Tufts-New England Medical Center, Boston, MA.
authors.forename: J S
authors.initials: JS
authors.lastname: Gill
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006084:Graft Rejection / Q000209:etiology*; D006085:Graft Survival; D006801:Humans; D007676:Kidney Failure, Chronic / Q000601:surgery*; D007677:Kidney Function Tests; D016030:Kidney Transplantation / Q000009:adverse effects*; D008875:Middle Aged; D011183:Postoperative Complications; D011247:Pregnancy; D011248:Pregnancy Complications; D011379:Prognosis; D012307:Risk Factors; D013997:Time Factors; D055815:Young Adult
keywords: clinical research/practice; kidney failure/injury; kidney transplantation/nephrology; obstetrics and gynecology; pregnancy