SOMANZ Oral Presentation Australasian Diabetes in Pregnancy Society and Society of Obstetric Medicine Australia and New Zealand Joint Scientific Meeting 2025

Graft outcomes following pregnancy with a functioning kidney transplant in Australia and New Zealand (128544)

Su Jen Chua 1 2 , Christopher E Davies 1 3 , Renuka Shanmugalingam 1 4 5 , Angela Makris 1 4 5 , Jennifer Yo 1 6 7 , Arunima Jain 1 8 9 10 , Nishanta Tangirala 1 3 11 , Amanda Sluiter 1 12 13 , Brooke Huuskes 1 14 , Franziska Pettit 1 5 11 , Lai Wan Chan 1 15 , Erin Vaughan 1 16 17 , Melanie Wyld 1 16 17 , Shilpa Jesudason 1 18
  1. Australian and New Zealand Dialysis and Transplant (ANZDATA) Registry Parenthood Working Group, South Australian Health & Medical Research Institute, Adelaide, South Australia, Australia
  2. Mercy Hospital for Women, Heidelberg West, VICTORIA, Australia
  3. School of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
  4. Department of Nephrology, Liverpool Hospital, Liverpool, New South Wales, Australia
  5. School of Medicine, Western Sydney University, Sydney, New South Wales, Australia
  6. Department of Nephrology, Monash Health, Clayton, Victoria, Australia
  7. School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
  8. Department of Obstetric Medicine, Royal Hospital for Women, Sydney, New South Wales, Australia
  9. Department of Nephrology, Prince of Wales Hospital, Sydney, New South Wales, Australia
  10. Faculty of Medicine & Health, University of New South Wales, Sydney, New South Wales, Australia
  11. Department of Renal Medicine, St George Hospital, Kogarah, New South Wales, Australia
  12. Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia
  13. Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
  14. Centre for Cardiovascular Biology and Disease Research, La Trobe University, Melbourne, Victoria, Australia
  15. Department of Renal Medicine, Waikato Hospital, Hamilton, New Zealand
  16. Department of Renal Medicine, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
  17. Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
  18. Central and Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, South Australia, Australia

Introduction: Pregnancy post-kidney transplantation carries higher risks of preterm birth, preeclampsia, and adverse fetal outcomes (1, 2). Concerns about the impact of pregnancy on graft function influence parenthood decisions and this knowledge gap is crucial to address in preconception counselling(3).

Objective: To evaluate the impact of pregnancy on graft survival in women with a functioning kidney transplant compared to matched non-pregnant controls. 

Methods: Observational study of Australian and New Zealand Dialysis and Transplant (ANZDATA) Registry data. Graft survival was compared between women aged 15-49 years with a functioning kidney transplant with a first pregnancy between 2001-2023, and matched non-pregnant women. Matching was based on transplant duration, preconception serum creatinine, and maternal age. Surgical terminations were excluded. Multiple pregnancies and pregnancies ending with miscarriages at >20 weeks gestation were included. Graft survival was calculated from the time of conception.

Results: 286 first pregnancies in 284 women with a kidney transplant were compared to 286 matched women. Mean maternal age at conception was 32±4.9 years with median preconception serum creatinine 103µmol/L (interquartile range [IQR]:88-123). Median transplant duration at conception was 4.5 years (IQR:2.5-8). After median follow-up of 8.7 years from conception, pregnancy was not associated with poorer graft survival after adjusting for maternal age, preconception creatinine, donor source, graft number and time from start of dialysis until transplantation (HR 1.21 (95%CI:0.89, 1.64).  

Conclusion: Pregnancy in women with a functioning kidney transplant was not associated with adverse impact on long-term graft survival. These findings will inform clinicians and women considering pregnancy after transplantation.

  1. 1. Rose C, Gill J, Zalunardo N, Johnston O, Mehrotra A, Gill JS. Timing of Pregnancy After Kidney Transplantation and Risk of Allograft Failure. Am J Transplant. 2016;16(8):2360-7.
  2. 2. Wyld ML, Clayton PA, Jesudason S, Chadban SJ, Alexander SI. Pregnancy outcomes for kidney transplant recipients. Am J Transplant. 2013;13(12):3173-82.
  3. 3. Tong A, Jesudason S, Craig JC, Winkelmayer WC. Perspectives on pregnancy in women with chronic kidney disease: systematic review of qualitative studies. Nephrol Dial Transplant. 2015;30(4):652-61.