Preeclampsia and Long-term Renal Function in Women Who Underwent Kidney Transplantation
Preeclampsia and Long-term Renal Function in Women Who Underwent Kidney Transplantation
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DOI：
10.1097/aog.0000000000002404
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发表时间：
2018-01-01
影响因子：
7.2
通讯作者：
Van Mieghem, Tim
中科院分区：
文献类型：
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作者：
Vannevel, Valerie;Claes, Kathleen;Van Mieghem, Tim
目的：子痫前期常常使母体肾移植后妊娠并发症。我们的目的是评估是否先兆子痫与肾功能下降，无论是在怀孕期间或在长期。方法：我们进行了一项国际多中心回顾性队列研究。收集肾移植后妊娠并在参与中心接受移植和产科护理的女性的受孕时肾功能、妊娠结局以及短期和长期移植结局。在研究期间多次怀孕的女性中，仅包括最后一次怀孕。结果：我们检索了52名妇女的妊娠结局和长期肾脏结局。27%的患者基线时存在慢性高血压。妊娠开始时平均估计肾小球滤过率（GFR）为52.4 ± 17.5 mL/min/1.73 m（2）。分娩时平均估计GFR为47.6621.6 mL/min/1.73 m2，显著低于受孕时（P=.03）。20名妇女（38%）发展为先兆子痫。在多变量分析中，发生先兆子痫的妇女在受孕和分娩之间的GFR估计值下降10.7 mL/min/1.73 m2，高于未发生先兆子痫的妇女（P= 0.02）。在中位5.8年（范围1.3-27.5年）时获得了长期估计GFR随访。末次随访时平均估计GFR为38623 mL/kg/1.73 m（2）。17名女性（33%）在随访期间发生移植物丢失。在最后一次妊娠中，有和没有先兆子痫的妇女的移植物丢失发生率相似（分别为30%和34%; P= 0.99）。在多变量分析中，在妊娠期间发生先兆子痫的女性和未发生先兆子痫的女性中，从受孕到最后一次随访，GFR估计值的下降相似（差异为22.69 mL/min/1.73 m（2），P= 0.65）。结论：先兆子痫通常使肾移植后妊娠并发症，但与长期肾功能不全或移植物丢失无关。
OBJECTIVE: Preeclampsia often complicates pregnancies after maternal kidney transplantation. We aimed to assess whether preeclampsia is associated with kidney function decline either during the pregnancy or in the long term.METHODS: We performed an international multicenter retrospective cohort study. Renal function at conception, pregnancy outcomes, and short-and long-term graft outcomes were collected for women who were pregnant after renal transplantation and had transplant and obstetric care at the participating centers. In women who had multiple pregnancies during the study period, only the last pregnancy was included. Univariate and multivariable analyses were performed.RESULTS: We retrieved pregnancy outcomes and longterm renal outcomes for 52 women. Chronic hypertension was present at baseline in 27%. Mean estimated glomerular filtration rate (GFR) at start of pregnancy was 52.4 +/- 17.5 mL/min/1.73 m(2). Mean estimated GFR at delivery was 47.6621.6 mL/min/1.73 m(2), which was significantly lower than at conception (P=.03). Twenty women (38%) developed preeclampsia. In multivariable analysis, women who developed preeclampsia had a 10.7-mL/min/1.73 m(2) higher drop in estimated GFR between conception and delivery than women who did not develop preeclampsia (P=.02). Long-term estimated GFR follow-up was obtained at a median of 5.8 years (range 1.3-27.5 years). Mean estimated GFR at last follow-up was 38623 mL/kg/1.73 m(2). Seventeen women (33%) experienced graft loss over the follow-up period. Incidence of graft loss was similar in women with and without preeclampsia in their last pregnancy (30% and 34%, respectively; P=.99). In multivariable analysis, the decrease in estimated GFR between conception and last follow-up was similar in women who experienced preeclampsia during pregnancy and those who did not (difference 22.69 mL/min/1.73 m(2), P=.65).CONCLUSION: Preeclampsia commonly complicates pregnancies after renal transplantation but is not associated with long-term renal dysfunction or graft loss.