Long-term Outcomes Associated With Post-kidney Donation Pregnancy Complications.
Long-term Outcomes Associated With Post-kidney Donation Pregnancy Complications.
复制标题
与肾捐赠后妊娠并发症相关的长期结果。
DOI：
10.1097/tp.0000000000004540
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发表时间：
2023
期刊：
影响因子：
6.2
通讯作者：
Matas,ArthurJ
中科院分区：
文献类型：
--
作者：
Palzer,EliseF;Helgeson,ErikaS;Evans,MichaelD;Vock,DavidM;Matas,ArthurJ
背景：肾脏捐献者患上捐献后妊娠高血压和先兆子痫的风险增加。在一般人群中，妊娠并发症与产妇的长期风险有关。然而，很少有数据表明捐赠后妊娠相关并发症的捐赠者是否有类似的长期风险增加。我们研究了捐赠后gHTN、先兆子痫/子痫或妊娠期糖尿病（gDM）是否与高血压、糖尿病、心血管疾病或估计肾小球滤过率< 45 mL/min/1.73 m2的风险增加相关。采用序贯考克斯回归分析和稳健的标准误比较结局的发生率。排除了捐赠前妊娠并发症的捐赠者。模型调整了怀孕年龄，妊娠，捐赠年份，高血压，糖尿病和心脏病家族史。结果：在384名捐赠后怀孕的捐赠者中（捐赠后中位数[四分位数]随访27.0 [14.2-36.2]年），39名经历了先兆子痫/子痫，29名gHTN无先兆子痫，17名gDM。从献血到首次妊娠先兆子痫的中位间隔为5.1（2.9-8.6）年; gHTN为3.7（1.9-7.8）年; gDM为7.3（3.7-10.3）年。先兆子痫/子痫（风险比[HR] 2.70; 95%置信区间[CI]，1.53-4.77）和gHTN（HR 2.39; 95% CI，1.24-4.60）与高血压的发生相关。先兆子痫/子痫（HR 2.15; 95% CI，1.11-4.16）和gDM（HR 5.60; 95% CI，1.41-22.15）与DM的发生相关。妊娠相关并发症与心血管疾病风险增加或估计肾小球滤过率< 45 mL/min/1.73 m2无关。结论：在我们的单中心研究中，捐赠后先兆子痫、gHTN或gDM与高血压或DM的长期风险相关。
Background.Kidney donors have increased risk of postdonation gestational hypertension (gHTN) and preeclampsia. In the general population, pregnancy complications are associated with long-term maternal risk. However, little data exist on whether donors with postdonation pregnancy-related complications have similar increased long-term risks. We studied whether postdonation gHTN, preeclampsia/eclampsia, or gestational diabetes (gDM) was associated with increased risk of developing hypertension, DM, cardiovascular disease, or estimated glomerular filtration rate< 45 mL/min/1.73 m 2.Methods.Postdonation pregnancies with complications were matched to pregnancies without complications based on time from donation. Incidence of outcomes was compared using sequential Cox regression with robust standard errors. Donors with predonation pregnancy complications were excluded. Models were adjusted for age at pregnancy, gravidity, year of donation, and family history of hypertension, DM, and heart disease.Results.Of the 384 donors with postdonation pregnancies (median [quartiles] follow-up of 27.0 [14.2–36.2] y after donation), 39 experienced preeclampsia/eclampsia, 29 gHTN without preeclampsia, and 17 gDM. Median interval from donation to first pregnancy with preeclampsia was 5.1 (2.9–8.6) y; for gHTN, 3.7 (1.9–7.8) y; and for gDM, 7.3 (3.7–10.3) y. Preeclampsia/eclampsia (hazard ratio [HR] 2.70; 95% confidence interval [CI], 1.53-4.77) and gHTN (HR 2.39; 95% CI, 1.24-4.60) were associated with development of hypertension. Preeclampsia/eclampsia (HR 2.15; 95% CI, 1.11-4.16) and gDM (HR 5.60; 95% CI, 1.41-22.15) were associated with development of DM. Pregnancy-related complications were not associated with increased risk of cardiovascular disease or estimated glomerular filtration rate< 45 mL/min/1.73 m 2.Conclusions.In our single-center study, postdonation preeclampsia, gHTN, or gDM was associated with long-term risk of hypertension or DM.