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Medical/Surgical/Diseases/Complications

Poster Session 4

(978) Severe maternal morbidity and adverse pregnancy outcomes in patients with history of kidney transplant

Wednesday, February 14, 2024
1:00 PM – 2:30 PM  
Location: Prince George's Exhibit Hall CDE, Lower Atrium Level
Objective: To determine the odds of severe maternal morbidity (SMM) in patients with a pre-pregnancy history of kidney transplant.

Study Design: This study was conducted using the TriNetX Diamond Network, a health research network with data from 92 health care organizations from inception in 2009-8/2023. Pregnant patients aged 12-55 years with pre-pregnancy history of kidney transplant and no history of transplant rejection/other transplant complication were compared to those without a history of kidney transplant. Primary outcome was composite SMM defined using Centers for Disease Control ICD-10 codes. Individual indicators of SMM and other adverse pregnancy outcomes (preeclampsia, postpartum hemorrhage, cesarean delivery, and spontaneous preterm delivery) were investigated as secondary outcomes. The TriNetX platform was used to run 1:1 propensity score matching and logistic regression. Variables included in propensity score matching were age, race, ethnicity, chronic hypertension, history of heart disease, diabetes mellitus, and obesity.

Results: After propensity score matching, there were 706 individuals included in each cohort (Table). Patients with history of kidney transplant had higher odds of composite SMM (OR 4.62, 95% CI 3.09-6.92), acute renal failure (OR 8.52, 95% CI 4.37-16.61), sepsis (OR 2.77, 95% CI 1.33-5.76), spontaneous preterm delivery (OR 1.86, 95% CI 1.20-2.89), and preeclampsia (OR 2.32, 95% CI 1.51-3.57). When acute renal failure was removed from composite SMM, there were still increased odds of SMM in the renal transplant group (OR 2.59, 95% CI 1.68-3.99). There was no significant difference between groups in odds of cardiac arrest/ventricular fibrillation (OR 1.17, 95% CI 0.54-2.55), blood transfusion (OR 1.72, 95% CI 0.78-3.78), cesarean section (OR 1, 95% CI 0.81-1.24), or postpartum hemorrhage (OR 1.64, 95% CI 0.90-2.98).

Conclusion:

Patients with a history of kidney transplant have increased odds of composite SMM, primarily driven by increased odds of acute renal failure.