Current Transplantation Reports

, Volume 3, Issue 1, pp 10–14 | Cite as

Considerations for Living Kidney Donation Among Women of Childbearing Age: Evidence from Recent Studies

Live Kidney Donation (KL Lentine, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Live Kidney Donation

Abstract

Each year, approximately 16,000 women become living kidney donors worldwide, donating a kidney to a spouse, family member, or friend. A common concern of women with childbearing potential is whether donation will affect future pregnancy outcomes. The first studies to examine pregnancy outcomes after living kidney donation were mostly reassuring; however, the two largest reported an increased risk of gestational hypertension and preeclampsia in groups of women with pregnancies after donation compared with groups of women with pregnancies before donation. A concern for donation-related risk was recently confirmed in an 11-year cohort study of 85 female donors and 510 healthy non-donors who were carefully matched on baseline risk factors. Donors were 2.4 times more likely to be diagnosed with gestational hypertension or preeclampsia (95 % CI 1.2 to 5.0) compared with healthy non-donors (the combined incidence was 11.5 vs. 4.8 %, respectively). Most donor pregnancies, however, were uncomplicated, with no increased risk for pre-term birth, low birth weight, or Caesarian section and no maternal or neonatal deaths. Importantly, black women were not represented in the three major studies to date, and future research should examine whether risk differs across donor subgroups. As well, a better understanding is needed of the clinical sequelae of gestational hypertension and preeclampsia, including long-term renal outcomes. Based on current evidence, we believe that potential donors with reproductive potential should be counseled on the possibility of a greater likelihood of gestational hypertension or preeclampsia if they choose to donate a kidney, with knowledge that the probability of the most serious outcomes (stillbirth, neonatal death, maternal death) is extremely low.

Keywords

Gestational hypertension Living kidney donation Preeclampsia Pregnancy 

Notes

Compliance with Ethical Standards

Conflict of Interest

Amit Garg reports grants from Astellas and Roche. Jessica Sontrop has no relevant disclosures.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References

Papers of particular interest, published recently, have been highlighted as: •• Of major importance

  1. 1.
    Wolfe RA, Ashby VB, Milford EL, Ojo AO, Ettenger RE, Agodoa LY, et al. Comparison of mortality in all patients on dialysis, patients on dialysis awaiting transplantation, and recipients of a first cadaveric transplant. N Engl J Med. 1999;341:1725–30.CrossRefPubMedGoogle Scholar
  2. 2.
    Evans RW, Manninen DL, Garrison LP, Hart LG, Blagg CR, Gutman RA, et al. The quality of life of patients with end-stage renal disease. N Engl J Med. 1985;312:553–9.CrossRefPubMedGoogle Scholar
  3. 3.
    Roberts SD, Maxwell DR, Gross TL. Cost-effective care of end-stage renal disease: a billion dollar question. Ann Intern Med. 1980;92:243–8.CrossRefPubMedGoogle Scholar
  4. 4.
    Whiting JF, Kiberd B, Kalo Z, Keown P, Roels L, Kjerulf M. Cost-effectiveness of organ donation: evaluating investment into donor action and other donor initiatives. Am J Transplant. 2004;4:569–73.CrossRefPubMedGoogle Scholar
  5. 5.
    Reese PP, Boudville N, Garg AX. Living kidney donation: outcomes, ethics, and uncertainty. Lancet. 2015;385:2003–13.CrossRefPubMedGoogle Scholar
  6. 6.
    Horvat LD, Shariff SZ, Garg AX. Global trends in the rates of living kidney donation. Kidney Int. 2009;75:1088–98.CrossRefPubMedGoogle Scholar
  7. 7.
    Reese PP, Bloom RD, Feldman HI, Rosenbaum P, Wang W, Saynisch P, et al. Mortality and cardiovascular disease among older live kidney donors. Am J Transplant. 2014;14:1853–61.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Segev DL, Muzaale AD, Caffo BS, Mehta SH, Singer AL, Taranto SE, et al. Perioperative mortality and long-term survival following live kidney donation. JAMA. 2010;303:959–66.CrossRefPubMedGoogle Scholar
  9. 9.
    Garg AX, Meirambayeva A, Huang A, Kim J, Prasad GVR, Knoll G, et al. Cardiovascular disease in kidney donors: matched cohort study. BMJ. 2012;344:e1203.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Garg AX, Muirhead N, Knoll G, Yang RC, Prasad GVR, Thiessen-Philbrook H, et al. Proteinuria and reduced kidney function in living kidney donors: a systematic review, meta-analysis, and meta-regression. Kidney Int. 2006;70:1801–10.CrossRefPubMedGoogle Scholar
  11. 11.
    Boudville N, Prasad GVR, Knoll G, Muirhead N, Thiessen-Philbrook H, Yang RC, et al. Meta-analysis: risk for hypertension in living kidney donors. Ann Intern Med. 2006;145:185–96.CrossRefPubMedGoogle Scholar
  12. 12.
    Tong A, Chapman JR, Wong G, Kanellis J, McCarthy G, Craig JC. The motivations and experiences of living kidney donors: a thematic synthesis. Am J Kidney Dis. 2012;60:15–26.CrossRefPubMedGoogle Scholar
  13. 13.
    Schutte JM, Steegers EAP, Schuitemaker NWE, Santema JG, de Boer K, Pel M, et al. Rise in maternal mortality in the Netherlands. BJOG. 2010;117:399–406.CrossRefPubMedGoogle Scholar
  14. 14.
    Rochat RW, Koonin LM, Atrash HK, Jewett JF. Maternal mortality in the United States: report from the maternal mortality collaborative. Obstet Gynecol. 1988;72:91–7.PubMedGoogle Scholar
  15. 15.
    Ngoc NTN, Merialdi M, Abdel-Aleem H, Carroli G, Purwar M, Zavaleta N, et al. Causes of stillbirths and early neonatal deaths: data from 7993 pregnancies in six developing countries. Bull World Health Organ. 2006;84:699–705. World Health Organization.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    American College of Obstetricians and Gynecologists (ACOG) Committee on Obstetric Practice. ACOG practice bulletin. Diagnosis and management of preeclampsia and eclampsia. Obstet Gynecol. 2002;99:159–67. Number 33, January 2002.CrossRefGoogle Scholar
  17. 17.
    Koopmans CM, Bijlenga D, Groen H, Vijgen SMC, Aarnoudse JG, Bekedam DJ, et al. Induction of labour versus expectant monitoring for gestational hypertension or mild pre-eclampsia after 36 weeks’ gestation (HYPITAT): a multicentre, open-label randomised controlled trial. Lancet. 2009;374:979–88.CrossRefPubMedGoogle Scholar
  18. 18.
    Hladunewich MA, Kim SJ. Kidney donation: what might it mean for women wishing to become pregnant. Am J Kidney Dis. 2015;66(3):386–8.CrossRefPubMedGoogle Scholar
  19. 19.
    Guidi E, Cozzi M, Milani S, Spada E. Nephrectomy modifies renal angiotensin II effects in kidney donors. Am J Hypertens. 2008;21:592–8.CrossRefPubMedGoogle Scholar
  20. 20.
    Conrad KP, Gandley RE, Ogawa T, Nakanishi S, Danielson LA. Endothelin mediates renal vasodilation and hyperfiltration during pregnancy in chronically instrumented conscious rats. Am J Physiol Ren Physiol. 1999;276:F767–76.Google Scholar
  21. 21.
    Lindheimer MD, Davison JM, Katz AI. The kidney and hypertension in pregnancy: twenty exciting years. Semin Nephrol. 2001;21:173–89.CrossRefPubMedGoogle Scholar
  22. 22.
    Gibson KJ, Thomson CL, Boyce AC, Karime BM, Lumbers ER. Effects of a reduction in maternal renal mass on pregnancy and cardiovascular and renal function of the pregnant ewe. Am J Physiol Ren Physiol. 2006;290:F1153–62.CrossRefGoogle Scholar
  23. 23.
    Packham DK, Hewitson TD, Whitworth JA, Kincaid-Smith PS. Glomerulosclerosis and hyalinosis in rabbits. Pathology. 1992;24:164–9.CrossRefPubMedGoogle Scholar
  24. 24.
    Delmonico F. A report of the Amsterdam forum on the care of the live kidney donor: data and medical guidelines. Transplantation. 2005;79:S53–66.CrossRefPubMedGoogle Scholar
  25. 25.
    Nevis IF, Garg AX. Maternal and fetal outcomes after living kidney donation. Am J Kidney Dis. 2009;9:661–8.Google Scholar
  26. 26.
    Ibrahim HN, Akkina SK, Leister E, Gillingham K, Cordner G, Guo H, et al. Pregnancy outcomes after kidney donation. Am J Transplant. 2009;9:825–34.CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Reisaeter AV, Røislien J, Henriksen T, Irgens LM, Hartmann A. Pregnancy and birth after kidney donation: the Norwegian experience. Am J Transplant. 2009;9:820–4.CrossRefPubMedGoogle Scholar
  28. 28.
    Wrenshall LE, McHugh L, Felton P, Dunn DL, Matas AJ. Pregnancy after donor nephrectomy. Transplantation. 1996;62:1934–6.CrossRefPubMedGoogle Scholar
  29. 29.
    Jones JW, Acton RD, Elick B, Granger DK, Matas AJ. Pregnancy following kidney donation. Transplant Proc. 1993;25:3082.PubMedGoogle Scholar
  30. 30.
    Buszta C, Steinmuller DR, Novick AC, Schreiber MJ, Cunningham R, Popowniak KL, et al. Pregnancy after donor nephrectomy. Transplantation. 1985;40:651–4.CrossRefPubMedGoogle Scholar
  31. 31.
    Josephson MA. Transplantation: pregnancy after kidney donation: more questions than answers. Nat Rev Nephrol. 2009;5:495–7.CrossRefPubMedGoogle Scholar
  32. 32.
    Nayak-Rao S. Pregnancy after kidney donation—placing things in perspective. Saudi J Kidney Dis Transpl. 2011;22:552–3.PubMedGoogle Scholar
  33. 33.
    Baillargeon J. Characteristics of the healthy worker effect. Occup Med. 2001;16:359–66.PubMedGoogle Scholar
  34. 34.
    Fehrman-Ekholm I, Elinder CG, Stenbeck M, Tydén G, Groth CG. Kidney donors live longer. Transplantation. 1997;64:976–8.CrossRefPubMedGoogle Scholar
  35. 35.••
    Garg AX, Nevis IF, McArthur E, Sontrop JM, Koval JJ, Lam NN, et al. Gestational hypertension and preeclampsia in living kidney donors. N Engl J Med. 2015;372:124. An 11-year cohort study of 85 female donors and 510 healthy non-donors (carefully matched on baseline risk). Donors were 2.4 times more likely to be diagnosed with gestational hypertension or preeclampsia than non-donors.CrossRefPubMedPubMedCentralGoogle Scholar
  36. 36.
    Hays RE. Informed consent of living kidney donors: pitfalls and best practice. Curr Transpl Rep. 2015;2:29–34.CrossRefGoogle Scholar
  37. 37.
    O’Brien TE, Ray JG, Chan W-S. Maternal body mass index and the risk of preeclampsia: a systematic overview. Epidemiology. 2003;14:368–74.PubMedGoogle Scholar
  38. 38.
    Bodnar LM, Ness RB, Markovic N, Roberts JM. The risk of preeclampsia rises with increasing prepregnancy body mass index. Ann Epidemiol. 2005;15:475–82.CrossRefPubMedGoogle Scholar
  39. 39.
    Muzaale AD, Massie AB, Wang M-C, Montgomery RA, McBride MA, Wainright JL, et al. Risk of end-stage renal disease following live kidney donation. JAMA. 2014;311:579–86.CrossRefPubMedPubMedCentralGoogle Scholar
  40. 40.
    Lentine KL, Schnitzler MA, Xiao H, Axelrod D, Garg AX, Tuttle-Newhall JE, et al. Consistency of racial variation in medical outcomes among publicly and privately insured living kidney donors. Transplantation. 2014;97:316–24.CrossRefPubMedPubMedCentralGoogle Scholar
  41. 41.
    Lentine KL, Schnitzler MA, Xiao H, Saab G, Salvalaggio PR, Axelrod D, et al. Racial variation in medical outcomes among living kidney donors. N Engl J Med. 2010;363:724–32.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer International Publishing AG 2016

Authors and Affiliations

  1. 1.Division of Nephrology, Department of MedicineWestminster Tower, London Health Sciences CentreLondonCanada
  2. 2.Department of Epidemiology and BiostatisticsWestern UniversityLondonCanada

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