title: Outcomes of Pregnancies After Kidney Transplantation: Lessons Learned From CKD. A Comparison of Transplanted, Nontransplanted Chronic Kidney Disease Patients and Low-Risk Pregnancies: A Multicenter Nationwide Analysis.
abstract: Kidney transplantation (KT) may restore fertility in chronic kidney disease (CKD). The reasons why maternofetal outcomes are still inferior to the overall population are only partially known. Comparison with the CKD population may offer some useful insights for management and counselling.Aim of this study was to analyse the outcomes of pregnancy after KT, compared with a large population of nontransplanted CKD patients and with low-risk control pregnancies, observed in Italy the new millennium.
  
  
  
  We selected 121 live-born singletons after KT (Italian study group of kidney in pregnancy, national coverage about 75%), 610 live-born singletons in CKD, and 1418 low-risk controls recruited in 2 large Italian Units in the same period (2000-2014). The following outcomes were considered: maternal and fetal death; malformations; preterm delivery; small for gestational age (SGA) baby; need for the neonatal intensive care unit; doubling of serum creatinine or increase in CKD stage. Data were analyzed according to kidney diseases, renal function (staging according to CKD-epidemiology collaboration), hypertension, maternal age, parity, ethnicity.
  
  
  
  Maternofetal outcomes are less favourable in CKD and KT as compared with the low-risk population. CKD stage and hypertension are important determinants of results. Kidney transplantation patients with estimated glomerular filtration rate greater than 90 have worse outcomes compared with CKD stage 1 patients; the differences level off when only CKD patients affected by glomerulonephritis or systemic diseases ("progressive CKD") are compared with KT. In the multivariate analysis, risk for preterm and early-preterm delivery was linked to CKD stage (2-5 vs 1: relative risk 3.42 and 3.78) and hypertension (RR 3.68 and 3.16) while no difference was associated with being a KT or a CKD patient.
  
  
  
  The maternofetal outcomes in patients with kidney transplantation are comparable with those of nontransplanted CKD patients with similar levels of kidney function impairment and progressive and/or immunologic kidney disease.
authors.affiliation: 1 Department of Clinical and Biological Sciences, University of Torino, Nephrologie, Le Mans Hospital, Le Mans, France. 2 UOC Nefrologia, Azienda Ospedaliera Brotzu, Cagliari, Italy. 3 SCDU Obstetrics Department of Surgical Sciences, Città della Salute e della Scienza, University of Torino, Torino, Italy. 4 U.O. Nefrologia Dialisi e Trapianto, Dipartimento delle Insufficienze d'Organo e dei Trapianti, Policlinico S. Orsola, Bologna, Italy. 5 SC Nefrologia, AO Niguarda Ca' Granda, Milan, Italy. 6 Renal Transplantation Center 'A.Vercellone', Division of Nephrology Dialysis and Transplantation, Department of Medical Sciences, Città della Salute e della Scienza University of Torino, Torino, Italy. 7 UO Nefrologia Azienda Ospedaliero-Universitaria di Parma, Parma, Italy. 8 UOC Nefrologia 2, Dialisi e Trapianto, ARNAS Civico, Palermo, Italy. 9 U.O.C. Nefrologia e Dialisi, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy. 10 Divisione di Nefrologia, Dialisi e Trapianto, Azienda Ospedaliera Universitaria 'San Giovanni di Dio e Ruggi d'Aragona', Salerno, Italy. 11 UOC Nefrologia e Dialisi, Ospedale San Martino, Belluno, Italy. 12 Department of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, Vicenza, Italy. 13 SOC di Nefrologia, Dialisi e Trapianto Renale, Azienda Ospedaliero-Universitaria "S. Maria della Misericordia," Udine, Italy. 14 Department of Nephrology, Azienda Ospedaliero-Universitaria Policlinico Bari, Bari, Italy. 15 Nephrology and Dialysis, Taormina Hospital, Taormina, Italy. 16 SSD Epidemiology, Department of Clinical and Biological Sciences, AOU san Luigi, University of Torino, Torino, Italy.
authors.forename: Giorgina Barbara
authors.initials: GB
authors.lastname: Piccoli
authors.forename: Gianfranca
authors.initials: G
authors.lastname: Cabiddu
authors.forename: Rossella
authors.initials: R
authors.lastname: Attini
authors.forename: Martina
authors.initials: M
authors.lastname: Gerbino
authors.forename: Paola
authors.initials: P
authors.lastname: Todeschini
authors.forename: Maria Luisa
authors.initials: ML
authors.lastname: Perrino
authors.forename: Ana Maria
authors.initials: AM
authors.lastname: Manzione
authors.forename: Gian Benedetto
authors.initials: GB
authors.lastname: Piredda
authors.forename: Elisa
authors.initials: E
authors.lastname: Gnappi
authors.forename: Flavia
authors.initials: F
authors.lastname: Caputo
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Montagnino
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Bellizzi
authors.forename: Pierluigi
authors.initials: P
authors.lastname: Di Loreto
authors.forename: Francesca
authors.initials: F
authors.lastname: Martino
authors.forename: Domenico
authors.initials: D
authors.lastname: Montanaro
authors.forename: Michele
authors.initials: M
authors.lastname: Rossini
authors.forename: Santina
authors.initials: S
authors.lastname: Castellino
authors.forename: Marilisa
authors.initials: M
authors.lastname: Biolcati
authors.forename: Federica
authors.initials: F
authors.lastname: Fassio
authors.forename: Valentina
authors.initials: V
authors.lastname: Loi
authors.forename: Silvia
authors.initials: S
authors.lastname: Parisi
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Versino
authors.forename: Antonello
authors.initials: A
authors.lastname: Pani
authors.forename: Tullia
authors.initials: T
authors.lastname: Todros
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D007558:Italy / Q000453:epidemiology; D016030:Kidney Transplantation; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology*; D011256:Pregnancy Outcome; D012042:Registries; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology* / Q000601:surgery; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D055815:Young Adult