Bootcongres

Introduction Since the beginning of our living transplant program in 1981 until July 2013, 1462 living donors have donated a kidney, 804 (55%) were female and 259 (18%) were at the time of donation 45 years or younger. As these women are in their childbearing years they wonder if donation will interfere with a future pregnancy. Our research question was: is pregnancy after living kidney donation more problematic than pregnancies in the general population, and what is the impact of pregnancy on the solitary kidney function on the long term.

Methods A literature search was done on pregnancy and living donation. We searched Pubmed, search terms included combinations on pregnancy, living donation and outcomes.

Results Literature on this subject is very scarce. We identified 4 original retrospective research studies. Two small retrospective single center studies, one national retrospective database studies performed in Norway and one large single center survey performed in the USA. These 4 studies did not show any differences in complications compared to the general population. In the two large studies they also compared pre- versus post donation pregnancies. In the analysis of the Norwegian study pre-eclampsia after donation was more common in pregnancies after donation 6/106 (5,7%), than in pregnancies before donation 16/620 (2,6%). The large single center survey from the USA associated post donation pregnancies with a lower likelihood of full-term deliveries (73,7% vs. 84,6% p=0,0004) and a higher likelihood of fetal loss compared to the pre donation pregnancies (19,2% vs. 11,3%, p<0,0001). They were also associated with a higher risk of gestational diabetes (2,7% vs. 0,7%, p=0,0001), gestational hypertension, proteinuria (4,3% vs. 1,1%, p<0,0001) and preeclampsia (5,5% vs. 0,8%, p<0,0001).

Discussion For young females it is of great importance if a living donation will interfere with a future pregnancy wish. Fetal and maternal outcomes were the same compared to the general population. The inferior post-donation outcomes compared to pre-donation outcomes may not only be caused by donation as increasing age is also associated with adverse fetal and maternal outcomes. At present insufficient data are available to conclude that kidney donation adversely affects the future pregnancies of women of childbearing age. We propose a national study to address whether this holds true for the Dutch donor population.