Speaker: Pregnancy complications should be part of informed consent for kidney donors
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Women who experienced complications during pregnancies that occurred prior to kidney donation were at increased risk for developing hypertension and diabetes up to 27 years after donation.
Due to the observed long-term risks, researchers from the University of Minnesota recommend pregnancy complications be considered during risk assessment for living donors and be a part of informed consent policies.
“In the general population, we know that pregnancy complications like gestational hypertension, diabetes and preeclampsia are associated with the risk of developing cardiovascular disease and diabetes,” Erika S. Helgeson, PhD, said at the virtual American Transplant Congress. “Our study question was whether kidney donors who have pre-donation pregnancy complications are also at increased risk.”
To investigate, Helgeson and colleagues considered the incidence of cardiovascular disease, hypertension and diabetes in 1,862 women who donated a kidney between 1963 and 2020, matching each woman who had pregnancy complications with 10 women who had no complications (mean age at the time of donation was 42 years; mean number of pregnancies before donation was three).
Donors were followed for 9 to 27 years, with a median follow-up of 18 years.
Results indicated donors who had gestational hypertension were at greater risk for developing hypertension (HR = 2.06) and diabetes (HR = 2.92) after donation, while those who had gestational diabetes were at greater risk for developing diabetes (HR = 4.17).
“Overall, we observed similar findings to the general population, with pregnancy complications pre-donation being associated with long-term risk of developing cardiovascular disease, diabetes and hypertension,” Helgeson said, noting that gestational hypertension and preeclampsia showed moderate associations with cardiovascular disease.
Helgeson acknowledged limitations to the study – including the “small amount” of women who had pre-donation complications during pregnancy – making it necessary to conduct further research.
“If our findings are confirmed among other centers, we suggest that this data be part of informed consent and candidates who have pre-donation pregnancy complications should be accepted as donors with caution after considering other factors,” she said.
“Work remains to determine the attributable risk that kidney donation has on the outcomes.”
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Helgeson ES, et al. Live kidney donation. Presented at: American Transplant Congress; June 4 - June 9, 2021. (Virtual meeting).
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