Pre-kidney Donation Pregnancy Complications and Long-term Outcomes.
Pre-kidney Donation Pregnancy Complications and Long-term Outcomes.
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DOI：
10.1097/tp.0000000000004146
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发表时间：
2022-10-01
期刊：
影响因子：
6.2
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中科院分区：
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高血压和糖尿病是年轻候选人活体肾脏捐赠的禁忌症。然而，人们对出现这些妊娠相关并发症并随后成为捐赠者的妇女的长期结果知之甚少。在一般人群中，妊娠期高血压(GHtn)、先兆子痫/子痫和妊娠期糖尿病(GDM)与长期风险相关。采用近邻倾向评分匹配方法，将有指定捐献前并发症的供者与同期妊娠无并发症的对照供者进行配对。采用Logistic回归方法，结合妊娠、血压、血糖、体重指数、年龄、捐献时的肌酐、捐献年份、种族、与受赠者的关系和家族病史等协变量，评估患者的倾向性得分。使用比例风险模型比较两组之间高血压、糖尿病、心血管疾病(CVD)和肾功能减退(EGFR<；30，EGFR<；45mL/min/1.73m2)的长期发病率。在1862名捐献者中，48人患有先兆子痫/子痫，49人患有无先兆子痫的妊娠期肾病，43人患有妊娠期糖尿病。供者第一次怀孕到捐献的间隔时间较长(中位数为18.5年，IQR：10.6~27.5年)，捐献后的随访时间较长(中位数18.0，IQR：9.2~27.7年)。妊娠期糖尿病与糖尿病相关(HR：3.04，95%CI：1.33~6.99)。妊娠并发症与EGFR<；30或EGFR<；45mL/min/1.73m2无关。我们的数据表明，即使有正常的捐赠者评估，患有捐献前妊娠相关并发症的女性也有长期风险。有妊娠相关并发症史的捐献者应该得到关于这些风险的咨询。
Hypertension and diabetes are contraindications for living kidney donation in young candidates. However, little is known about long-term outcomes of women who had these pregnancy-related complications and subsequently become donors. In the general population, gestational hypertension (GHtn), preeclampsia/eclampsia, and gestational diabetes (GDM) are associated with long-term risks. Donors with the specified predonation complication were matched to contemporary control donors with pregnancies without the complication using nearest neighbor propensity score matching. Propensity scores were estimated using logistic regression with covariates for gravidity, blood pressure, glucose, BMI, age, and creatinine at donation, donation year, race, relationship to recipient, and family history of disease. Long-term incidence of hypertension, diabetes, cardiovascular disease (CVD), and reduced renal function (eGFR<30, eGFR<45 mL/min/1.73m2) were compared between groups using proportional hazards models. Of 1862 donors with predonation pregnancies, 48 had preeclampsia/eclampsia, 49 had GHtn without preeclampsia, and 43 had GDM. Donors had a long interval between 1st pregnancy and donation (median 18.5 years, IQR: 10.6-27.5) and a long postdonation follow-up time (median 18.0, IQR: 9.2-27.7 years). GHtn was associated with development of hypertension (HR: 1.89, 95% CI: 1.26-2.83); GDM was associated with diabetes (HR: 3.04, 95% CI: 1.33-6.99). Pregnancy complications were not associated with eGFR<30 or eGFR<45 mL/min/1.73m2 . Our data suggests that even with a normal donor evaluation, women with predonation pregnancy-related complications have long-term risks. Donor candidates with a history of pregnancy-related complications should be counseled about these risks.