Pregnancy and Kidney Transplantation

The aim of this thesis is to provide insight into themes surrounding pregnancy after kidney transplantation in the Netherlands. First, a meta-analysis was performed into the effect of pregnancy on kidney function and the risk of graft loss in women after kidney transplantation. Only shortly after pregnancy was a mild significant effect on graft function observed. There was no difference in graft loss between kidney transplant-recipients with and without pregnancy. Subsequently, the national PARTOUT dataset (Pregnancy After Renal Transplantation OUTcomes) was established to investigate short- and long-term pregnancy outcomes after kidney transplantation. For the first time, this study shows pregnancy outcomes by preconception kidney function category on a large scale, including women with worse kidney function. Overall obstetric outcomes in kidney transplant-recipients are good. Pregnancy after kidney transplantation has no significant effect on long-term kidney function. Mid-term glomerular hyperfiltration, a physiological adaptation to pregnancy, is associated with better graft survival. Poor kidney function and poor hemodynamic adjustment to pregnancy are risk factors for adverse pregnancy outcomes. While the results are reassuring, kidney transplants have an expiration date and kidney transplant recipients may again require renal replacement therapy when their child is young. Furthermore, interviews showed that kidney transplant-recipients experience a barrier for discussing their pregnancy wish with the nephrologist. Given the low incidence of pregnancy after kidney transplantation, pregnancy outcomes are not always correctly estimated by nephrologists and gynaecologists. Finally, in women after kidney donation, pregnancy has no negative effect on long-term kidney function. There is a higher incidence of hypertensive disease in pregnancy after kidney donation, but no higher incidence of fetal outcomes compared to pregnancies before kidney donation.