TY - JOUR
T1 - Pregnancy after living kidney donation, a systematic review of the available evidence, and a review of the current guidance
AU - Pippias, Maria
AU - Skinner, Laura
AU - Noordzij, Marlies
AU - Reisæter, Anna Varberg
AU - Abramowicz, Daniel
AU - Stel, Vianda S.
AU - Jager, Kitty J.
N1 - Funding Information: The authors of this manuscript have conflicts of interest to disclose as described by the . Dr Maria Pippias and Dr Laura Skinner are currently funded by the National Institute for Health Research (NIHR). The review was not registered on Prospero. The review protocol can be supplied on request. An earlier version of this article has been published as part of a doctoral thesis and is currently under embargo. American Journal of Transplantation 62 Publisher Copyright: © 2022 The Authors. American Journal of Transplantation published by Wiley Periodicals LLC on behalf of The American Society of Transplantation and the American Society of Transplant Surgeons.
PY - 2022/10
Y1 - 2022/10
N2 - Understanding and communicating the risk of pregnancy complications post-living kidney donation is imperative as the majority of living kidney donors (LKD) are women of childbearing age. We aimed to identify all original research articles examining complications in post-donation pregnancies and compared the quality and consistency of related guidelines. We searched Embase, MEDLINE, PubMed, society webpages, and guideline registries for English-language publications published up until December 18, 2020. Ninety-three articles were screened from which 16 studies were identified, with a total of 1399 post-donation pregnancies. The outcome of interest, post-donation pregnancy complications, was not calculable, and only a narrative synthesis of the evidence was possible. The absolute risk of pre-eclampsia increased from ~1%–3% pre-donation (lower than the general population) to ~4%–10% post-donation (comparable to the general population). The risks of adverse fetal and neonatal outcomes were no different between post-donation and pre-donation pregnancies. Guidelines and consensus statements were consistent in stating the need to inform LKDs of their post-donation pregnancy risk, however, the depth and scope of this guidance were variable. While the absolute risk of pregnancy complications remains low post-donation, a concerted effort is required to better identify and individualize risk in these women, such that consent to donation is truly informed.
AB - Understanding and communicating the risk of pregnancy complications post-living kidney donation is imperative as the majority of living kidney donors (LKD) are women of childbearing age. We aimed to identify all original research articles examining complications in post-donation pregnancies and compared the quality and consistency of related guidelines. We searched Embase, MEDLINE, PubMed, society webpages, and guideline registries for English-language publications published up until December 18, 2020. Ninety-three articles were screened from which 16 studies were identified, with a total of 1399 post-donation pregnancies. The outcome of interest, post-donation pregnancy complications, was not calculable, and only a narrative synthesis of the evidence was possible. The absolute risk of pre-eclampsia increased from ~1%–3% pre-donation (lower than the general population) to ~4%–10% post-donation (comparable to the general population). The risks of adverse fetal and neonatal outcomes were no different between post-donation and pre-donation pregnancies. Guidelines and consensus statements were consistent in stating the need to inform LKDs of their post-donation pregnancy risk, however, the depth and scope of this guidance were variable. While the absolute risk of pregnancy complications remains low post-donation, a concerted effort is required to better identify and individualize risk in these women, such that consent to donation is truly informed.
KW - donor nephrectomy
KW - donor outcomes
KW - kidney transplantation
KW - living donor
KW - pre-eclampsia
UR - http://www.scopus.com/inward/record.url?scp=85135214249&partnerID=8YFLogxK
U2 - https://doi.org/10.1111/ajt.17122
DO - https://doi.org/10.1111/ajt.17122
M3 - Article
C2 - 35716049
SN - 1600-6135
VL - 22
SP - 2360
EP - 2380
JO - American Journal of Transplantation
JF - American Journal of Transplantation
IS - 10
ER -