Gestational Hypertension and Preeclampsia in Living Kidney Donors

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http://www.nejm.org/doi/full/10.1056/NEJMoa1408932?query=featured_home

Gestational Hypertension and Preeclampsia in Living Kidney Donors
Amit X. Garg, M.D., Ph.D., Immaculate F. Nevis, Ph.D., Eric McArthur, M.Sc., Jessica M. Sontrop, Ph.D., John J. Koval, Ph.D., Ngan N. Lam, M.D., Ainslie M. Hildebrand, M.D., Peter P. Reese, M.D., Leroy Storsley, M.D., John S. Gill, M.D., Dorry L. Segev, M.D., Ph.D., Steven Habbous, M.Sc., Ann Bugeja, M.D., Greg A. Knoll, M.D., Christine Dipchand, M.D., Mauricio Monroy-Cuadros, M.D., and Krista L. Lentine, M.D., Ph.D. for the DONOR Network
DOI: 10.1056/NEJMoa1408932

Abstract

BACKGROUND
Young women wishing to become living kidney donors frequently ask whether nephrectomy will affect their future pregnancies.
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METHODS
We conducted a retrospective cohort study of living kidney donors involving 85 women (131 pregnancies after cohort entry) who were matched in a 1:6 ratio with 510 healthy nondonors from the general population (788 pregnancies after cohort entry). Kidney donations occurred between 1992 and 2009 in Ontario, Canada, with follow-up through linked health care databases until March 2013. Donors and nondonors were matched with respect to age, year of cohort entry, residency (urban or rural), income, number of pregnancies before cohort entry, and the time to the first pregnancy after cohort entry. The primary outcome was a hospital diagnosis of gestational hypertension or preeclampsia. Secondary outcomes were each component of the primary outcome examined separately and other maternal and fetal outcomes.
Full Text of Methods...
RESULTS
Gestational hypertension or preeclampsia was more common among living kidney donors than among nondonors (occurring in 15 of 131 pregnancies [11%] vs. 38 of 788 pregnancies [5%]; odds ratio for donors, 2.4; 95% confidence interval, 1.2 to 5.0; P=0.01). Each component of the primary outcome was also more common among donors (odds ratio, 2.5 for gestational hypertension and 2.4 for preeclampsia). There were no significant differences between donors and nondonors with respect to rates of preterm birth (8% and 7%, respectively) or low birth weight (6% and 4%, respectively). There were no reports of maternal death, stillbirth, or neonatal death among the donors. Most women had uncomplicated pregnancies after donation.
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CONCLUSIONS
Gestational hypertension or preeclampsia was more likely to be diagnosed in kidney donors than in matched nondonors with similar indicators of baseline health. (Funded by the Canadian Institutes of Health Research and others.)

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http://www.news1130.com/2014/11/14/living-kidney-donors-face-higher-health-risks-during-later-pregnancies-study/

Living kidney donors face higher health risks during later pregnancies: Study
Helen Branswell

A new study says that women who have donated a kidney are at higher risk of developing gestational hypertension or a potentially dangerous condition called pre-eclampsia during pregnancies that follow the donation.

The study suggests the increase in risk is not enormous, and in fact most women who have donated a kidney can safely carry a pregnancy to term.

But the authors say women of child-bearing age considering donating a kidney should be informed.

Women who have donated a kidney face an 11 per cent risk of developing one of these conditions; for women who have both kidneys, it’s a five per cent chance.

The study was presented Friday at a meeting of the American Society of Nephrology and is being published in the New England Journal of Medicine.

The lead author says the Number 1 question women who are thinking about donating a kidney ask is if giving up a kidney will affect their ability to have healthy pregnancies later.

Dr. Amit Garg is a scientist at Ontario’s Institute for Clinical Evaluative Sciences and director of the living donor program at Lawson Health Research Institute at the London Health Sciences Centre.

Garg says previous studies have shown conflicting results on this question, so he and his co-authors set out to see if they could find a clearer answer.

He says he’s talked with some women who have donated kidneys through his program, to get their take on the findings.

“Many women who we’ve talked to when they hear about these results still feel comfortable in their donation decision. And we fully expect many women who come forward to donate kidneys when hearing this information will still wish to proceed with donation,” says Garg, a nephrologist or kidney specialist.

He notes most living donors are giving up an organ out of love. While some people donate organs to strangers in need, the majority of donations are among family members.

The study looked at medical records of all women in Ontario who donated a kidney between July 1, 1992 and April 20, 2010 who went on to have at least one pregnancy after the donation, and compared their experiences to similar women who had not donated a kidney.

Fans of the TV show “Downton Abbey” will remember pre-eclampsia as the condition that killed Lady Sibyl during childbirth. It is the leading cause of maternal mortality.

Pre-eclampsia (the precursor to full-blown eclampsia) is a marked by a trio of classic symptoms — fluid retention, headaches and high blood pressure. While it can be fatal if untreated, ending the pregnancy by inducing delivery or performing a caesarean section will cure the condition.