{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T04:02:13Z","timestamp":1784606533430,"version":"3.55.0"},"reference-count":54,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2022,1,12]],"date-time":"2022-01-12T00:00:00Z","timestamp":1641945600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2022,1,12]],"date-time":"2022-01-12T00:00:00Z","timestamp":1641945600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Medizinische Hochschule Hannover (MHH)"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Nephrol"],"published-print":{"date-parts":[[2022,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>After kidney transplantation, pregnancy and graft function may have a reciprocal interaction. We evaluated the influence of graft function on the course of pregnancy and vice versa.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>We performed a retrospective observational study of 92 pregnancies beyond the first trimester in 67 women after renal transplantation from 1972 to 2019. Pre-pregnancy eGFR was correlated with outcome parameters; graft function was evaluated by Kaplan Meier analysis. The course of graft function in 28 women who became pregnant after kidney transplantation with an eGFR of\u2009&lt;\u200950\u00a0mL\/min\/1.73m<jats:sup>2<\/jats:sup> was compared to a control group of 79 non-pregnant women after kidney transplantation during a comparable time period and with a matched basal graft function.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>Live births were 90.5% (fetal death <jats:italic>n<\/jats:italic>\u2009=\u20099). Maternal complications of pregnancy were preeclampsia 24% (graft loss 1, fetal death 3), graft rejection 5.4% (graft loss 1), hemolytic uremic syndrome 2% (graft loss 1, fetal death 1), maternal hemorrhage 2% (fetal death 1), urinary obstruction 10%, and cesarian section.\u00a0(76%). Fetal complications were low gestational age (34.44\u2009\u00b1\u20095.02\u00a0weeks) and low birth weight (2322.26\u2009\u00b1\u2009781.98\u00a0g). Mean pre-pregnancy eGFR was 59.39\u2009\u00b1\u200917.62\u00a0mL\/min\/1.73m<jats:sup>2<\/jats:sup> (15% of cases\u2009&lt;\u200940\u00a0mL\/min\/1.73m<jats:sup>2<\/jats:sup>). Pre-pregnancy eGFR correlated with gestation week at delivery (<jats:italic>R<\/jats:italic>\u2009=\u20090.393, <jats:italic>p<\/jats:italic>\u2009=\u20090.01) and with percent eGFR decline during pregnancy (<jats:italic>R<\/jats:italic>\u2009=\u20090.243, <jats:italic>p<\/jats:italic>\u2009=\u20090.04). Pregnancy-related eGFR decline was inversely correlated with the time from end of pregnancy to chronic graft failure or maternal death (<jats:italic>R<\/jats:italic>\u2009=\u2009-0.47, <jats:italic>p<\/jats:italic>\u2009=\u20090.001). Kaplan Meier curves comparing women with pre-pregnancy eGFR of\u2009\u2265\u200950 to\u2009&lt;\u200950\u00a0mL\/min showed a significantly longer post-pregnancy graft survival in the higher eGFR group (<jats:italic>p<\/jats:italic>\u2009=\u20090.04). Women after kidney transplantation who became pregnant with a low eGFR of\u2009&gt;\u200925 to\u2009&lt;\u200950\u00a0mL\/min\/1.73m<jats:sup>2<\/jats:sup> had a marked decline of renal function compared to a matched non-pregnant control group (eGFR decline in percent of basal eGFR 19.34\u2009\u00b1\u200922.10%, <jats:italic>n<\/jats:italic>\u2009=\u200928, versus 2.61\u2009\u00b1\u200910.95%, <jats:italic>n<\/jats:italic>\u2009=\u200979, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.0001).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>After renal transplantation, pre-pregnancy graft function has a key role for pregnancy outcomes and graft function. In women with a low pre-pregnancy eGFR, pregnancy per se has a deleterious influence on graft function.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Trial registration<\/jats:title>\n                <jats:p>Since this was a retrospective observational case series and written consent of the patients was obtained for publication, according to our ethics\u2019 board the analysis was exempt from IRB approval. Clinical Trial Registration was not done. The study protocol was approved by the Ethics Committee of Hannover Medical School, Chairman Prof. Dr. H. D. Troeger, Hannover, December 12, 2015 (IRB No. 2995\u20132015).<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12882-022-02665-2","type":"journal-article","created":{"date-parts":[[2022,1,12]],"date-time":"2022-01-12T07:08:01Z","timestamp":1641971281000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":23,"title":["Graft function and pregnancy outcomes after kidney transplantation"],"prefix":"10.1186","volume":"23","author":[{"given":"Anke","family":"Schwarz","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roland","family":"Schmitt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gunilla","family":"Einecke","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frieder","family":"Keller","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ulrike","family":"Bode","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hermann","family":"Haller","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hans Heinrich","family":"Guenter","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2022,1,12]]},"reference":[{"issue":"3","key":"2665_CR1","doi-asserted-by":"crossref","first-page":"343","DOI":"10.1097\/00000658-195809000-00004","volume":"148","author":"JE Murray","year":"1958","unstructured":"Murray JE, Merrill JP, Harrison JH. 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D. Troeger, Hannover, December 12, 2015 (IRB No. 2995\u20132015), one year before start of the study in 2017. Written informed consent of the patients to participate in the study was obtained. Since this was a retrospective observational case series and written consent of the patients was obtained for publication, according to the ethics\u2019 board the analysis was exempt from IRB approval. Principles as outlined in the \u201cDeclaration of Helsinki\u201d and the \u201cDeclaration of Istanbul on Organ Trafficking and Transplant Tourism\u201d were respected.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"In the written informed of the patients consent for participation in the study, a written consent for publication of the anonymous results of the study was included.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors of this manuscript have conflicts of interest to disclose: H.H. has received Lecture fees and Consultancy from Bayer, Vifor Pharma, Fresenius, Boehringer, Alexia, AstraZeneca, Sciarc AG; Board Member fees from Bayer, Vifor Pharma, Fresenius, Boehringer, Alexion, AstraZeneca; Research Grants from Vifor Pharma, Boehringer, AstraZeneca; No Travel Grants. The other authors declare that they have no financial or non-financial competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"27"}}