V. Gestational Hypertension and Preeclampsia in Living Kidney Donors
This is one of the key articles that changed our understanding of the risk of donation.
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- Please summarise this article in your own words
- How did they reach this conclusion?
- Will this article change your practice?
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Will you accept a 22-year-old female who has not started her family yet as a kidney donor?
Thank you prof
No
Women Who were included in the study had at least one pregnancy with a gestation of at least 20 weeks (inclusion criteria)
Hi Dr Abdallah,
What is your logic for ‘at least one pregnancy with a gestation of at least 20 weeks’?
I am neither agreeing or disagreeing with yo by raising this question
The definition of Gestational HTN is taking place beyond the 20th of pregnancy and pre-eclampsia is a complication of Gestational HTN.
the question is attractive to be tried whatever that coming after the reply.
Thankyou Ben very wise.
Actually, still a difficult decision to be made, a lot of considerations should be evaluated including
1. This study didn’t include females who didn’t get pregnant before
2. No data regarding proteinuria, creatinine, follow-up labs during and after pregnancy
3. Other complications related to pregnancy like recurrent UTI, obstructive uropathy, increase of proteinuria, and progression to ESRD are not mentioned
4. Most living donation is related and carries the risk of genetically related kidney diseases and ESRD.
So, counseling the patient throw multidisplinary team is mandatory before accepting her as a potential donor
What is very true about your answer is:
If this is emotionally drived donation then there must be :
counsilling with full review of possible consequences.
She should be fully investigated inside out.
yes i will accept in case of complete history taking and full clinical examination and full investigations to all predisposing factors of hypertension and possible causes
complete counselling should be done and consent should be signed after telling her all hazards
if no family history of kidney disease, renal function and GFR are fine and the donor is agree and know all complications , so why not?
we can accept her
Very important aspect of your investigations is a phsycological one if the donation is not emotionally derived and it is only an alltruestic one.
If she informed about the risk of donation & importance of intensive medical care during pregnancy & she accept to be a donor, yes I will accept ( in my country we accept young unmarried female )
Yes, I have seen that happening in India where I worked as an assistant professor in 1996-2000. It is often the weakest link (may be a young female member) in the extended family who is ‘volunteered to come forward’ for kidney donation. This poses a serious ethical issue for everyone concerned because the potential recipient may be the only earning member and the cadaveric organ donation is not established.
One similar offer came from a year 2 medical student who came forward for altruistic kidney donation (to someone unknown) so that she can feel happy by saving someone’s life. That happened after a lecture on ethics.
After explanation of the possible complication post donation, I will accept this donor.but if available other donors, I will keep this young female as the last option.
If no other conditions that preclude transplantation I will leave the decision to the donor, I will explain that there is a mild increase in the risk of gestational HTN and preeclampsia that can occur during pregnancy that is usually mild and easily managed
I will tell her that she should have more regular visits once she came pregnant
I will advice her to avoid smoking, obesity
Well done.
Good evening, Dr. Professor Ahmed Halawa
A 22-year-old donor whose family has not yet started, I think she will be accepted if she meets the conditions for donating a kidney such as age and is in good health
For example, in the Arab Republic of Egypt, the kidney donor must be 21 years old in Palestine. The permissible age for kidney donation is over 18 years old, and he must be of the first degree, such as her father, mother, or brothers. by the kidneys.
Post donation need good follow up .
Dear Dr Ahmed,
The medical answer to the question is Yes, she can donate (the subject is healthy with no current medical contra-indication and she is 22 years old, which makes her able to decide by herself)
On the other hand, ethically, I feel the decision is not that easy. A real risk of maternal complications later on can not be accurately predicted in unmarried females. Additionally, the risk of developing gestational diabetes or other health-related problems (HTN and Type 2 DM) generally increases with ageing.
Finally, cultural differences will also play a role in decision-making. For example, some rural areas in our local community will consider the kidney donor to be a generous person who sacrificed for his relative. Still, at the same time, they will look to the donor as being weaker than normal just because he is living with one kidney instead of two. For a young female, this may affect her future life and her chances of getting married. Therefore, in similar cases from this cultural background, I will reject the case (most of them are happy when I tell them in the presence of the family that they are not suitable for donation, which indicates the undeclared pressure from the family).
So, I think this is a very tricky question as there will be no clear answer by Yes or No. Instead, each case has its unique medical and social circumstances, which may lead to different decision-making for a similar medical situation.
Thankyou for mentioning the undeclared family pressures which could be there in cases of daughters or sisters.
Well done.
Yes, I will accept her as a donor with providing her information about the increased risk for gestational HTN and preeclampsia
We have many considerations we need to keep in mind;
Is there an alternative donor or not?
Is the potential donor has no condition to preclude her from the donation?
I agree with Dr. Aref about considering the Cultural differences.
Any donors with reproductive potential should be counselled on the possibility of gestational hypertension or preeclampsia if they choose to donate a kidney, with the knowledge that the probability of the most serious outcomes (stillbirth, neonatal death, maternal death) is extremely low. I will accept it as the last option.
Well done.
Yes, i can accept if the following condition are met
Agree .
According to him, the gender of a donor should not be a determinant factor, provided such a donor is healthy and has two functioning kidneys.in other hand counselling should be carry on regarding risk of HTN and small risk of decrease eGFR.and consequence on her future pregancy.
Thankyou.
That is a very complex question. The study would prefer not to allow such a donor but again it would depend on many factors. If the potential donor still insists that she wants to donate despite adequate counseling about the risks and is willing to sign the consent form – then I would submit the case to the ethics committee.
Again – as the overall fetal and maternal outcomes were not different – no increased mortality, then the patients autonomy would supersede the tenet of non-malficience
I will accept her as a potential kidney donor as there is no contraindication to donate. I will counsel her regarding the probability of gestational HTN and pre-eclampsia.
Yes, if she is welling to donate but i will make her clearly know the risk of gestational HTN and preeclampia, specially in the first two years afetr donation.
Yea but should be counselling regarding possible of gestational hypertension and preeclampsia in future and should be mentioned in informed consent regarding consequences of nephrectomy during pregnancy and should be multidisciplinary team from nephrologist and obstetrician and neonatal consultation with monitoring blood pressure and medication during pregnancy and renal function and proteinuria monitoring with close fallow up by ultrasound for neonates
This is a challenging scenario (seen quiet often in our setting)
We try to find an alternative donor in family (ours being a living related transplant program, especially where female family members are sometimes emotionally forced to undergo donor nephrectomy).
But if no other donor available in family, then detailed counselling of the donor, especially regarding the consequences with respect to hypertension, ESRD, risks during future pregnancy etc should be done.
The donor needs to be evaluated in detail.
Such a donor is taken up for donor nephrectomy only once both the above parameters are fulfilled.
Although we come across such prospective donors, more often than not, we are able to find an alternative donor in the family, it just requires a little more probing/ persuation.
Realy currently i have one donor 23 yr old female her mother recently started dialysis before 4 month , ESKD because of hypertensive nephropathy , so her daughter insist to donate her kidney and she no more and more abuot the sequele from the internet and askind and discussing many issues with us .
when we are councelling her about the futuer health and social life , she always said that , i am doing which i think its right things and she is very beleive on that she may be rewarded as she donate her kidney to her mother , and the bad things may develop even in non donor ladies regarding their pregnancy .
her file prepared and she is currently processing her donation
there is no absolute CI to donation for her but in general we ( according to paper and studies in the last 2 week in this module) prefer older donor , male side
Councelling about the donation as young female not yet involve in her future family and the social as well as post donation pregnancy related out come , shpuld be clearly clarified to the donor , other wise if no other option , can be accepted .
Its tough decision,
Suggest other donors, if none
Explain in details and clearly the possible risk and make sure she understands it all, and still willing to proceed according to patient wish we will go for transplantation.
Advice control BP, BMI and Careful follow up thought out her pregnancies.
she can proceed with donation after extensive evaluation and discuss the risk of PET and gestational HTN
In this case we have at least 2 risk factors.
Age 21
Female not yet started her family
In BTS guideline
donors that have been placed on the transplant waiting list had donated between the ages of 18 and 34 years and developed ESRD >15 years after donation
Because she will have risked for other risk factors such as hypertension- DM – CVD…..
IN the other hand she has higher risk to develop preeclampsia and gestational hypertension
There is no contraindication to accept her but
This donor should have Careful psychological assessment is recommended before donation.
And well follow up her during her scheduled medical visits
yes, I will accept her as a donor if she is fit after a full medical-surgical, and psychosocial assessment, negative FH of renal disease and she is able to take the decision after a full explanation about the lifelong time renal risk including the impact on the future pregnancy outcome in terms of increased maternal and fetal risk together and should be referred for psychosocial assessment by independent personal not part of the transplant team.
I would like to inform prospective donor(22 year female) about risks of Gestational Hypertension and preeclampsia in future pregnancy to be more than double fold if she wishes to be a donor.
I shall try to evaluate if any other potential donor(older than her) available in the family and if so, would encourage him or her to donate rather than young female.
Deceased Donation is another option but this program in Northern part of India is practically very poor and have waiting list of years and will not help even to the most needy patients in the list.
In India, legally, we accept donors above 18 years of age and they are considered adults.
Since, she is in a state to decide(being older than 18 years) and its a patient driven decision whether to donate or not if any other potential donor in family doesn’t come in front to donate.
If she donates, she must be advised for regular health checkups as per protocol and special remark to her treating Obstetrician if she becomes pregnant.
Also, special mention to her regarding healthy lifestyle advises of weight management, light exercise, regular home BP monitoring and modest salt intake to be strictly followed during pregnancy
Emotionally driven decision overcomes future risks of morbidity especially in females and beyond ethical considerations.
Usually, I don’t. But if we have no choice there is no contraindication, as long as it will not increase mortality. I should clarify the risk for donation before she starts with the procedure
In our practice, we do not prefer young female donors of childbearing age (without previous delivery) except if obligatory after making sure that the probability of inherited illnesses is not. This is more important in case of strong family history of Ht or diabetes.
Previous history of preeclampsia and gestational Ht
This study presents a mixture of no history and a history of one or two pregnancies. Tough matching is 1:6 in the total population of the study, dependence on the ICD code is a handicap for this study. Another limitation is the small number of donor pregnancies; with an increase in numbers (in both groups, The odds rates may be less than shown
This is a retrospective cohort study to determine whether donors have a higher risk of gestational hypertension or preeclampsia. Gestational hypertension or preeclampsia was more common among living kidney donors than among nondonors (occurring in 15 of 131 pregnancies [11%] vs. 38 of 788 pregnancies [5%]; odds ratio for donors, 2.4; 95% confidence interval, 1.2 to 5.0; P=0.01). There were no significant differences between donors and nondonors with respect to rates of preterm birth (8% and 7%, respectively) or low birth weight (6% and 4%, respectively). There were no reports of maternal death, stillbirth, or neonatal death among the donors. Most women had uncomplicated pregnancies after donation.
Regular BP check up and follow up for lady in child bearing age.
In this Canadian cohort, gestational hypertension or preeclampsia was more likely to be diagnosed in living kidney donors than in matched nondonors with similar indicators of baseline health (incidence, 11% vs. 5%). Other important maternal and fetal outcomes did not differ significantly between the two groups, and there were no maternal or perinatal deaths. Most women had uncomplicated pregnancies after kidney donation.
Two previous studies have examined pregnancy outcomes after living kidney donation: a national study conducted in Norway and a single-center study conducted in Minnesota.The incidences of gestational hypertension, preeclampsia, and other maternal and fetal outcomes after donation in these studies were similar to the estimates in our study . In the two previous studies, the analyses compared outcomes in a group of women who were pregnant before donation with outcomes in a group of women who were pregnant after donation. The Minnesota study surveyed donors by asking them to recall outcomes many years after pregnancy, and more than 24% of women were lost to follow-up. The Norwegian study provided an additional comparison between donor pregnancies and nondonor pregnancies among women in the same birth registry. However, on average, the maternal age was 5 years older among donors than among nondonors, and that comparison did not account for between-group differences in prognostic factors.
Our study has certain limitations. First, data with respect to blood pressure, renal function, body-mass index, and medication use during pregnancy were not available in our data sources. Second, accurate racial information was not available,although 71% of Ontario citizens are white, as are approximately 70% of donors. Hypertension after kidney donation is more common among black donors than among white donors,and whether the same is true of hypertension during pregnancy requires future study (<3% of Ontario citizens are black). Third, confidence intervals for risk estimates were wide. Fourth, physicians use clinical judgment when applying accepted diagnostic criteria for In addition, some donors may have had a genetic predisposition to kidney disease, which could have increased the risk of our primary study outcome among those in whom this condition developed. Sixty-five percent of the donors had a first-degree relative with kidney failure, and we assume that few nondonors had a similar family history, although such information was not available for nondonors. There were too few events to reliably assess the effect of family history on outcomes. Nevertheless, three details warrant consideration. First, the donors had to have excellent health to qualify for nephrectomy, and women who had signs of kidney disease during donor evaluation were excluded from donation. Second, the average time between donation and a subsequent pregnancy was only 4 years, which was a short interval for new kidney disease to develop. Third, given our study inclusion criteria, the 29% of donors who had been pregnant before donation had pregnancies that were uncomplicated by gestational hypertension or preeclampsia despite any genetic predisposition. Thus, it seems unlikely that a genetic predisposition to kidney disease in isolation would explain the study findings. However, a genetic predisposition in combination with a reduced glomerular filtration rate from donor nephrectomy could amplify the risk of gestational hypertension or preeclampsia. Living kidney donation
Our study and others show that probabilities of the most serious maternal and fetal outcomes remain low and are not significantly increased after donation.It is unknown whether the same holds true in countries in which women lack access to a similar quality of health care. For this reason, there may be a role for government programs to cover the costs of recommended pregnancy care for donors who lack health insurance, including any costs related to the treatment of hypertension
Most of young age females keen to donate a kidney inquire about the impact of kidney donation on future pregnancy . This retrospective cross sectional study aim to answer this question and varify the impact of kidney donation on future pregnancy, risk of pregnancy complication with hypertension and or preeclampsia.This study included 85 female kidney donors with 131 pregnancies after kidney donation and compared them with 510 healthy non donors from general population in Ontario , Canda.Kidney donations were between 1992 and 2009 with follow- up until March 2013. Both donors and nondonors participants
were matched in age, cohort entry year , residency, income level , number of pregnancies before entering the cohort and time to first pregnancy after cohort entry. The primary outcome of this study was a hospital diagnosis of gestational hypertension and or preeclampsia. Secondary outcomes included each component of primary outcome examined separately as well as other maternal and fetal complications and outcomes.
Results of the study
Incidence of gestational hypertension and preeclampsia were higher among donor gruop compared with non donors at rate of 11% Vs 5% respectively.
While no significant difference was found between the two groups regarding other fetal complications as preterm labor , fetal death or low birth weight or other maternal complications as maternal death.
Will this article change your practice:
in our center, we donot usually accept young females at child bearing peroid if they didnot complete their family or are willing to have more children.
Introduction:
Young women are now commonly share in kidney donation. Risk to future pregnancy
need to be addressed ,so informed consent can be given and patient or donors
autonomy kept.
Methods :
its a retrospective cohort study of living kidney donors involving 85 women (131
pregnancies after cohort entry) who were matched in a 1:6 ratio with 510 healthy
nondonors from the general population (788 pregnancies after cohort entry).
Kidney donations occurred between 1992 and 2009 in Ontario, Canada, with followup
through linked health care databases until March 2013.
The primary outcome was a hospital diagnosis of gestational hypertension or
preeclampsia.
Secondary outcomes were each component of the primary outcome examined separately
and other maternal and fetal outcomes.
Results :
Gestational hypertension or preeclampsia was more common among living kidney
donors than among nondonors (occurring in 15 of 131 pregnancies [11%] vs. 38 of 788
pregnancies [5%.
Each component of the primary outcome was also more common among donors (odds
ratio, 2.5 for gestational hypertension and 2.4 for preeclampsia).
There were no significant differences between donors and nondonors with respect to
rates of preterm birth (8% and 7%, respectively) or low birth weight (6% and 4%,
respectively). There were no reports of maternal death, stillbirth, or neonatal death
among the donors.
Most women had uncomplicated pregnancies after donation.
Conclusions :
Gestational hypertension or preeclampsia was more likely to be diagnosed in kidney
donors than in matched nondonors with similar indicators of baseline health.
review of all perioperative donor charts, careful selection of similar donors and\
nondonors, and minimal loss to follow-up (<4%).
Our study population had access to a system of universal health care benefits, in which
all health care encounters were recorded, and the pregnancies of donors and nondonors
had similarly high levels of health surveillance (with medians of 10 prenatal visits and 3
ultrasonographic examinations).
Women in child birth age should be counselled regarding risk to coming pregnancy and
helped to to make informed consent.
This is a retrospective cohort study in Canada which included all women who donated a kidney between July 1, 1992, and April 30, 2010, who had at least one pregnancy with a gestation of at least 20 weeks during follow-up. The primary outcome was assessed after 20 weeks of gestation. Pregnancies in Donors were 131 and a matched non doners pregnancies were 788
Gestational hypertension or preeclampsia (the primary outcome) was diagnosed in 53 women (15 donors and 38 nondonors) at 28 hospitals .The risk of this outcome was higher among donors than among nondonors . The two groups did not differ significantly with respect to other secondary maternal or fetal outcomes. Subgroup analyses showed that the odds ratio for the primary outcome in donors as compared with nondonors was significantly higher among women who were older than 32 years of age than among those who were 32 years of age or younger (P = 0.004 for interaction). In additional analyses, among both donors and nondonors, gestational hypertension or preeclampsia was associated with an increased likelihood of cesarean section or low birth weight .
The strengths of this study :
1- there is a manual review of all perioperative donor charts
2- careful selection of similar donors and nondonors
3- minimal loss to follow-up (<4%).
4-population had access to a system of universal health care benefits, in which all health care encounters were recorded, and the pregnancies of donors and nondonors had similarly high levels of health surveillance (with medians of 10 prenatal visits and 3 ultrasonographic examinations).
Limitations:
1- data of blood pressure, renal function, body-mass index, and medication use during pregnancy were not available in the data sources.
2- accurate racial information was not available,
3- confidence intervals for risk estimates were wide.
4- physicians use clinical judgment when applying accepted diagnostic criteria for gestational hypertension and preeclampsia, and not all diagnoses have the same medical significance.
5- some donors may have had a genetic predisposition to kidney disease
This article hasmotivated me to express the risks associated with future pregnancies to female donors.
1. Please summarise this article in your own words
The study is a Canadian retrospective analysis of the risk of developing gestational hypertension and pre-eclampsia among living kidney donors when compared to other equally healthy women.
The data found in the Canadian study are confirmed by other studies, although some limitations are important in this work, as they are other risk factors related to gestational hypertension and pre-eclampsia: racial information, data related to blood pressure, renal function and Body mass index.
An increase in the risk of gestational hypertension and pre-eclampsia was evidenced among the donors and there was no significant difference between the other outcomes between the two groups, such as: maternal death , stillbirth or neonatal death, among others.
2. How did they reach this conclusion?
Through a retrospective cohort study with a population of kidney donors who became pregnant combined with baseline characteristics of non-donors who would be healthy and eligible, the primary outcomes of gestational hypertension and pre-eclampsia were analyzed and, as secondary, other maternal-fetal outcomes such as: maternal death , stillbirth or neonatal death, among others.
Pregnancy characteristics and outcomes were analyzed using generalized linear mixed models with random intercept and random-effects logistic regression models, which account for correlation structure in paired sets and in women with more than one follow-up pregnancy.
In the results, it was evident the greater risk of primary outcomes among donors (11%) when compared to non-donors (5%) with Confidence Interval [CI] of 95%, 1.2 to 5.0; P=0.01.
3. Will this article change your practice?
In view of this finding, we need to be more emphatic regarding the ethics of informing the donor woman with reproductive desire that she has a higher risk of developing gestational hypertension and pre-eclampsia. It will also be necessary to make them aware that although studies do not show an increase in maternal or fetal mortality, it is important that they (donors) are monitored even more closely during the gestational period to manage this situation if necessary
Gestational Hypertension and Preeclampsia in Living Kidney Donors
Background
Young women who want to donate their kidneys as living donors frequently inquire about how nephrectomy could impact future pregnancies.
Methods
We conducted a retrospective cohort analysis of living kidney donors in which 510 healthy nondonors from the general population were matched in a 1:6 ratio with 85 women (131 pregnancies after cohort enrollment) (788 pregnancies after cohort entry). In Ontario, Canada, kidney donations took place between 1992 and 2009, with follow-up through connected health databases lasting until March 2013. Age, year of cohort entry, domicile (urban or rural), income, number of pregnancies before to cohort enrollment, and time to first pregnancy following cohort membership were all taken into consideration when matching donors and nondonors. The primary outcome was a hospital diagnosis of gesta- tional hypertension or preeclampsia. Secondary outcomes were each component of the primary outcome examined separately and other maternal and fetal outcomes.
Results
Living kidney donors were more likely than nondonors to experience gestational hypertension or preeclampsia (occurring in 15 of 131 pregnancies (11%) vs. 38 of 788 pregnancies (5%); odds ratio for donors.Additionally, among donors, each element of the primary outcome was more prevalent (odds ratio, 2.5 for gestational hypertension and 2.4 for preeclampsia). Preterm birth rates (8% and 7%, respectively) and low birth weight rates (6% and 4%, respectively) did not significantly differ between donors and nondonors. None of the donors had any known cases of maternal mortality, stillbirth, or neonatal death. Most donors experienced straightforward pregnancies.
Conclusions
Compared to matched nondonors with similar baseline health indicators, kidney donors were more likely to have gestational hypertension or preeclampsia identified.
This is a retrospective study in form of cohort of 85 women (131 pregnancies), matched with a control group from healthy general population. Primary outcome was gestational HTN or preeclampsia and the secondary outcome was other maternal and fetal outcomes. Gestational HTN or preeclampsia occurred in 11% of case groups compared to 5% of control group with odd ratio of 2.4 and significant difference between two groups. But they did not have any significant difference in terms of preterm birth or LBW or other complications of pregnancy.
This is a good retrospective cohort study with high power because of its high sample size. As it is not ethical to do a RCT about these subjects, maybe a prospective cohort study is a good substitute.
This article would change our practice at least in the form of donor’s consent. This should be
mentioned and young female donors should be informed about it.
Pregnancy with its all possible complications is a major concern in young women wishing to become living kidney donors.
Aim of the study:
To evaluate the risk gestational hypertension and preeclampsia following kidney donation.
Methods:
This is a retrospective cohort study of living kidney donors that occurred between 1992 and 2009 in Ontario, Canada.
It included 85 women who were matched with 510 healthy non-donors from the general population.
Donors and non-donors were matched for age, residency, income, number of pregnancies before cohort entry, and the time to the first pregnancy after cohort entry.
The primary outcome was the hospital diagnosis of gestational hypertension or preeclampsia.
Secondary outcomes were each component of the primary outcome examined separately and other maternal and fetal outcomes.
Results:
Gestational Hypertension or preeclampsia are more come among living kidney donors than non-donors
There were no significant differences between donors and non-donors with respect to rates of preterm birth or low birth weight.
Most women had uncomplicated pregnancies after donation.
Conclusion:
Donors are at higher risk of pregnancy induced hypertension or pre-eclampsia as compared to non-donors. However, it is not associated with perinatal or maternal mortality or pre term deliveries.
How did they reach this conclusion?
By comparing the primary & secondary outcomes between a cohort of women who donated a kidney & a cohort of healthy women (1:6 ratio) who were carefully selected & matched.
Will this article change your practice?
Yes, women who are planning their families should be counseled about this risk, However, there is no increased risk of serious maternal or fetal complications
Please summarize this article in your own words
This is a retrospective study using data from 5 transplantation centers in Canada to assess incidence of gestational hypertension and pre-eclampsia in living kidney donors.
Study population: 85 female donors.
Control Population: 510 healthy non-donors.
Follow up: median period of 10.9 years.
Results: 131 pregnancies in the donors’ population and 788 Pregnancies in the control group. Gestational HTN or Pre-eclampsia was higher in the donors 11% compared to control group in 5%. It was higher with donors aged more than 32 years. There was no difference between both groups regarding incidence of pre-term birth and low birth weight.
Most of pregnancy outcomes were relatively normal.
How did they reach this conclusion?
By manual review of all data, well matched controls, and long term follow up.

Will this article change your practice?
Pre-donation counselling of young female donors because of increased risk of gestational HTN and pre-eclampsia.
Gestational hypertension and preeclampsia in living kidney donors
Worldwide the majority of living kidney donors are women. Young female donors frequently ask whether kidney donation will affect future pregnancies. In humans, the glomerular filtration rate is reduced by about 35% early after donor nephrectomy,5 and women with a similar loss of kidney function from various diseases are at increased risk for preeclampsia. A prominent 2004 international conference concluded that kidney donation poses no risk with respect to future pregnancies. However, two studies show an increased risk of gestational hypertension and preeclampsia after kidney donation, this information is debated and many transplant centres do not include them in their informed consent.
Method
Retrospective, a matched-cohort study using linked health care databases in Ontario, Canada. Between 1992 and 2010.
Population
All donors are women who donate between July 1, 1992, and April 30, 2010, in Ontario and who had at least one pregnancy with a gestation of at least 20 weeks during follow-up. The primary outcome was assessed after 20 weeks gestation.
Non-donors
They identified a matched set of nondonors for 85 of 88 study-eligible donors, simulated nephrectomy date.
Women with age within the range of the donor, have evidence of at least one pregnancy carried to 20 weeks of gestation in follow-up. The non-donors had the same opportunity as donors to obtain health care services from physicians.
Then the authors matched six eligible nondonors to each donor on the basis of baseline characteristics that might be associated with the risk of gestational hypertension or preeclampsia.
Outcome:
Women were followed until death, emigration from the province, or the end of the observation period (March 31, 2013). The primary outcome was a hospital-based diagnostic code for either gestational hypertension or preeclampsia (from 20 weeks of gestation to 12 weeks after birth), as recorded in a health care or physician-claims database by a medical coder. Eclampsia number was few and for privacy regulations, such events were categorized as preeclampsia.
Maternal outcomes were counted only once per pregnancy. Fetal outcomes were nay birth weight < 2500 g.
Statistical analysis
Pregnancy characteristics and outcomes were analyzed with the use of generalized linear mixed models with a random intercept and random-effects logistic-regression models, which account for the correlation structure within matched sets and in women with more than one follow-up pregnancy. All analyses were performed with the use of SAS software, version 9.3 (SAS Institute).
Observation Time
Median of 10.9 years. With a maximum follow-up of 20 years.
Characteristics of the Study Participants
The median age was 29 years (interquartile range, 26 to 32), and 29% of the women had at least one pregnancy before cohort entry.
Most donors had more physician visits as part of donor evaluation.
Most donors were first-degree relatives 65%, followed by distant relatives or genetically unrelated donors (20%)m and spouses 15%
Serum creatinine before the donation was 0.76 mg/dl (0.69 – 0.83). median e GFR was 114 ml/min/1.73m2 (104 to 122)
Pregnancy:
All deliveries were performed in hospitals. Donors and non-donors had the same median number of healthcare visits. The number of previous pregnancies and the interval between pregnancies were the same in the two groups.
Study outcome
For gestational hypertension or preeclampsia, the risk of this was high in donors than in nondonor.
The two groups did not differ significantly with respect to other secondary maternal or fetal outcomes.
There were no maternal death, stillbirths or neonatal death in either group.
Discussion
In the Canadian cohort, gestational hypertension or preeclampsia was more likely to be diagnosed in living donors than in matched nondonors with similar indicators of baseline health (incidence, 11% vs. 5%). Most women had uncomplicated pregnancies after kidney donation. Two studies conducted in Norway and in Minnesota confirmed the same results. In the two previous studies, the analyses compared outcomes in a group of women who were pregnant before donation with outcomes in a group of women who were pregnant after donation.
Strength of the study:
The strengths of our study include a manual review of all perioperative donor charts, careful selection of similar donors and nondonors, and minimal loss to follow-up (<4%).
The pregnancies of donors and nondonors had similarly high levels of health surveillance.
Limitation of the study:
Data regarding blood pressure, renal function, body mass index and medication during pregnancy were not available. Racial information was not available. The confidence interval of the risk was wide.
Physicians use clinical judgment when applying accepted diagnostic criteria for gestational hypertension and preeclampsia, and not all diagnoses have the same medical significance.
I will emphasise more on counselling the donor about this risk and the importance of follow-up during pregnancy.
This study is one of the 3large studies done in this issue
They compared incidence of gestational HTN and preeclampsia between donors and non donors females in observation period 10.9 years in 5 centers in Ontario Canada .
The outcome was gestational HTN and preeclampia incidence was 11% in donors bs 5% in non donors
with no significant change in other pregnancy outcome
Almost same result concluded by monisota and Norway studies
If I have a donor who is young age I will search for other risk factors like obesity ,family history
then if no I will council her regarding the risks and I I will let her to take the decision
1. Please summarise this article in your own words
Females account for around 27000 of kidney donor world wide, the most important concern they have wether donation can affect pregnancy , as many studies showed that donation (having a single kidney) increases risk of hypertension and proteinuria hence pre eclampsia might be one of the risk to be confirmed for such population. There was a controversies between the studies . hence this study was conducted to assess risk of gestational hypertension or preeclampsia in donors and non donors with similar baseline health. maternal and fetal outcomes were also looked at.
Method
· Retrospective matched cohort study using linked health care databases.
· The perioperative medical charts of all persons who underwent donor nephrectomy at five transplantation centers were reviewed from 1992 to 2010.
· Data regarding demographic characteristics and vital status from Registered Persons Database were retrieved. The collected data regarding pregnancies (maternal and fetal) were assessed .
Population
Donors
· who had at least one pregnancy with a gestation of at least 20 weeks during follow-up were selected. (The primary outcome was assessed after 20 weeks of gestation.) Each woman’s nephrectomy date served as her cohort-entry date. new events during follow-up were assessed.
· 85 of 88 study-eligible donors were selected
Nondonors
· healthy people from general population were selected, using restriction and matching.
· included women with an age that was within the minimum and maximum ages of donors
· identified baseline illnesses and measures of health care access.
· This provided a median of 11 years of baseline assessment; 99% of the women had at least 2 years of available data.
· We restricted the sample of eligible nondonors to women without a known medical condition before cohort entry that could preclude donation, including a diagnosis of gestational hypertension or preeclampsia.
· ensured that nondonors had the same opportunity as donors to obtain health care services from physicians, by restricted the sample of eligible nondonors to women who had visited a physician at least once during the previous 2 years.
· These restrictions left 380,995 women (52% of the original sample) as eligible nondonors.
then matched six eligible nondonors to each donor on the basis of baseline characteristics that might be associated with the risk of gestational hypertension or preeclampsia,
Study Outcomes
· Women were followed until death.
· The number of eclampsia events was anticipated to be small,
· the risk anticipated to be higher among older women.
· All analyses were performed with the use of SAS software, version 9.3 (SAS Institute). Continuous data were summarized as medians and interquartile ranges.
Discussion
· gestational hypertension or preeclampsia was more likely to be diagnosed in living kidney donors than in matched nondonors with similar indicators of baseline health (incidence, 11% vs. 5%).
· Other important maternal and fetal outcomes did not differ significantly between the two groups,
· and there were no maternal or perinatal deaths.
· Most women had uncomplicated pregnancies after kidney donation.
· The results of the study were comparable with other studies.
Study strength
· manual review of all perioperative donor charts.
· careful selection of similar donors and nondonors.
· minimal loss to follow-up
· population had access to a system of universal health care benefits, in which all health care encounters were recorded.
· the pregnancies of donors and nondonors had similarly high levels of health surveillance
study limitations
· data with respect to blood pressure, renal function, body-mass index, and medication use during
· pregnancy were not available
· accurate racial information was not available,
· confidence intervals for risk estimates were wide.
· physicians use clinical judgment when applying accepted diagnostic criteria for gestational hypertension and preeclampsia, and not all diagnoses have the same medical significance.
· It remains possible that gestational hypertension and preeclampsia were more likely to
· be diagnosed and recorded among donors than among nondonors
· Urine protein may rise after nephrectomy which could also increase the chance of a diagnosis of preeclampsia among donors.
2.How did they reach this conclusion?
3 main points to be taken in account to confirm this :
· the donors had to have excellent health to qualify for nephrectomy,
· the average time between donation and a subsequent pregnancy was only 4 years, too short interval for new kidney disease to develop.
· donors who had been pregnant before donation had pregnancies that were uncomplicated by gestational hypertension or preeclampsia despite any genetic predisposition.
Thus, genetic predisposition is unlikely to be responsible but other factors could contributed.
2. Will this article change your practice?
· This article will make me emphasize on female patient counselling before i accept her as a donor, before she signs the consent she should be informed about all the possible risks including hypertension and proteinuria and pre eclampsia in addition to the fetal risk associated, even though it is minimal but she should be aware prior taking this decision of donation.
· To confirm her understanding I will refer her to the psychologist prior donations.
Introduction
The majority of living donors are commonly female donors. Young female donors are concerned by the effect of donation on their future plans of pregnancies. The glomerular filtration rate is reduced by about 35% early post donation and nephrectomy. Women are also at risk of renal diseases as well as risk of preeclampsia and subsequent further loss of renal function.
Few studies reported an increased risk of gestational hypertension and preeclampsia in pregnancies post renal donation, when compared with pregnancies prior to donation.
This study aims to determine whether female donors have a higher risk of gestational hypertension or preeclampsia than do nondonors, as well as fetal and maternal outcomes.
Study Design
Retrospective study between July 1992, and April 2010, female donors with at least one pregnancy with a gestation of at least 20 weeks during follow-up. Women in whom gestational hypertension or preeclampsia had been diagnosed before donation (in ≤5 women) were totally excluded.
Study Outcomes
The primary outcome was the development of either gestational hypertension or preeclampsia (from 20 weeks of gestation to 12 weeks after birth). The number of eclampsia events was anticipated to be small (incidence, <0.1% of pregnancies in the general population).
Observation Time
595 women (85 kidney donors and 510 nondonors) for a median of 10.9 years (11.0 years for donors and 10.9 years for nondonors) with maximum duration of 20 years.
The observation periods for 20 women (3.4%) were censored at the time of provincial emigration or death.
The last donation occurred in December 2009, and the last childbirth in December 2012.
Less than 2% of pregnancies were twins.
Characteristics of the Study Participants
The median age was 29 years (interquartile range, 26 to 32), and 29% of the women had at least one pregnancy before cohort entry.
Most donors (65%) were first-degree relatives (sibling, parent, or child) of the recipient, followed by distant relatives or genetically unrelated donors (20%) and spouses (15%).
Predonation, the median serum creatinine level was 0.76 mg per deciliter and the median estimated glomerular filtration rate was 114 ml per minute per 1.73 m2.
Study Outcomes
Gestational hypertension or preeclampsia was diagnosed in 53 women (15 donors and 38 nondonors).
This was higher among donors than those nondonors (11% vs. 5%; odds ratio for donors, 2.4; 95% confidence interval [CI], 1.2 to 5.0; P = 0.01).
There was no significant difference in terms of secondary maternal or fetal outcomes. No maternal deaths, stillbirths, or neonatal deaths were reported as well.
Among both donors and nondonors, gestational hypertension or preeclampsia was associated with an increased probability of cesarean section or low birth weight.
Discussion
Gestational hypertension or preeclampsia was more diagnosed in living renal donors than in nondonors. Maternal and fetal outcomes did not show significant difference at all. Most women had uncomplicated pregnancies post renal donation without any maternal or perinatal deaths.
Similarly, the incidences of gestational hypertension, preeclampsia, and other maternal and fetal outcomes post renal donation in both Norway and Minnesota studies were similar to the estimates of this study.
The strengths of this study are mainly the manual review of all perioperative donor charts, careful selection of similar donors and nondonors as well as minimal loss to follow-up.
Limitations involved the lack of information regarding blood pressure, renal function, body-mass index, and medication use during pregnancy.
Urine protein may increase after nephrectomy, which could also increase the chance of a diagnosis of preeclampsia among donors. Also, the average time between donation and following pregnancy was about 4 years, which was a short interval for a new kidney disease to develop.
A genetic predisposition in combination with a reduced glomerular filtration rate from donor nephrectomy could amplify the risk of gestational hypertension or preeclampsia.
They reached this conclusion by larger number of case studies, selection of matched control groups and follow up meticulously.
This article enlightens my clinical practice in terms of better information and application for candidate female donors of child bearing period and advising them for longer follow up post donation.
Background
Young women wishing to become living kidney donors frequently ask whether nephrectomy will affect their future pregnancies.
Methods
Results
Conclusions
Gestational hypertension or preeclampsia was more likely to be diagnosed in kidney donors than in matched nondonors with similar indicators of baseline health.
Will this article change your practice?
Yes, with this article we can counsel young female donors after the safety of their pregnancy and offspring with a increased risk of gestational hypertension.
Gestational Hypertension and Preeclampsia in Living Kidney Donors
Introduction:
The majority of living kidney donors are women and the young ones frequently ask whether nephrectomy will affect their future pregnancies.
In humans, the GFRis reduced by about 35% early after donor nephrectomy, and women with a similar loss of kidney function from various diseases are at increased risk for preeclampsia.
The aim of this study were:
1. To determine whether donors have a higher risk of gestational HTN or preeclampsia than do nondonors with similar indicators of baseline health.
2. To compare other maternal and fetal outcomes.
Methods
A retrospective cohort study of living kidney donors involving 85 women
(131 pregnancies after cohort entry) who were matched in a 1:6 ratio with 510 healthy nondonors from the general population (788 pregnancies after cohort entry).
Kidney donations occurred between 1992 and 2009 in Ontario, Canada, with followup through linked health care databases until March 2013.
Donors and nondonors were matched with respect to age, year of cohort entry, residency (urban or rural), income, number of pregnancies before cohort entry, and the time to the first pregnancy after cohort entry.
The primary outcome was a hospital diagnosis of gestational hypertension or preeclampsia. Secondary outcomes were each component of the primary outcome examined separately and other maternal and fetal outcomes.
Results
Gestational HTN or preeclampsia was more common among living kidney
donors than among nondonors (occurring in 15 of 131 pregnancies [11%] vs. 38 of 788 pregnancies [5].
Each component of the primary outcome was also more common among
donors (for gestational HTN and preeclampsia).
There were no significant differences between donors and nondonors with respect to rates of preterm birth (8% and 7%, respectively) or low birth weight (6% and 4%, respectively).
There were no reports of maternal death, stillbirth, or neonatal death
among the donors. Most women had uncomplicated pregnancies after donation.
The strengths of the study:
1. Include a manual review of all perioperative donor charts, careful
selection of similar donors and nondonors, and minimal loss to follow-up (<4%).
2. The study population had access to a system of universal health care benefits.
Limitations of the study:
1. Data with respect to blood pressure, renal function, BMI, and medication use during pregnancy were not available in the data sources.
2, Accurate racial information was not available (Hypertension after kidney donation is more common among black donors than among white donors).
3. Confidence intervals for risk estimates were wide.
4. Physicians use clinical judgment when applying accepted diagnostic criteria for gestational HTN and preeclampsia, and not all diagnoses have the same medical significance.
5. Some donors may have had a genetic predisposition to kidney disease, which
could have increased the risk of the primary study outcome among those in whom this condition developed.
Conclusions
The ethical practice of living kidney donation requires that professionals in the transplantation field provide donors with up-to-date, accurate information about risks (including pregnancy risks2) and acknowledge the limitations of what is
known.
Randomized trials of donation are not ethically feasible. An alternative approach
would be to perform a large, multicenter, prospective cohort study in which carefully selected donors and nondonors are enrolled over a period of several years and then followed for a decade, with adjudicated pregnancy outcomes.
Although there is some uncertainty regarding the true magnitude of risk, Information on this potential risk should be included in clinical practice
guidelines, shared in the informed-consent processes for potential donors and their recipients when a woman has reproductive potential, and used to guide the care of pregnant donors.
This study and others showed that probabilities of the most serious maternal and fetal outcomes remain low and are not significantly increased after donation.
Gestational hypertension or preeclampsia was more likely to be diagnosed in kidney donors than in matched nondonors with similar indicators of baseline health.
# Please summarise this article in your own words
# The aim of the study:
*To determine whether donors have a higher risk of gestational hypertension or preeclampsia than do non donors with similar indicators of baseline health.
*The study also compared other maternal and fetal outcomes.
#Introduction
*In humans, the GFR is reduced by about 35% early after donor nephrectomy,5 and women with a similar loss of kidney function from various diseases are at increased risk for preeclampsia.
*Some studies showed the risk of non gestational hypertension among kidney donors, as compared with non donors, have had conflicting results, with some studies showing an increased risk and others showing no increase in risk.
# Methods
*This is a retrospective cohort study of living kidney donors involving 85 women (131 pregnancies after cohort entry) who were matched in a 1:6 ratio with 510 healthy non donors from the general population (788 pregnancies after cohort entry).
*Kidney donations occurred between 1992 and 2009 in Ontario, Canada, with follow up through linked health care databases until March 2013.
* Donors and non donors were matched with respect to age, year of cohort entry, residency (urban or rural), income, number of pregnancies before cohort entry, and the time to the first pregnancy after cohort entry.
* The primary outcome was a hospital diagnosis of gestational hypertension or preeclampsia. *Secondary outcomes were each component of the primary outcome examined separately and other maternal and fetal outcomes.
# Result:
*Gestational hypertension or preeclampsia was more common among living kidney donors than among non donors (occurring in 15 of 131 pregnancies [11%] vs. 38 of 788 pregnancies [5%]; odds ratio for donors, 2.4; 95% confidence interval, 1.2 to 5.0; P = 0.01).
*Each component of the primary outcome was also more common among donors (odds ratio, 2.5 for gestational hypertension and 2.4 for preeclampsia).
*There were no significant differences between donors and non donors with respect to rates of preterm birth (8% and 7%, respectively) or low birth weight (6% and 4%, respectively).
*There were no reports of maternal death, stillbirth, or neonatal death among the donors.
*Most women had uncomplicated pregnancies after donation.
# Discussion:
*In this Canadian cohort, gestational hypertension or preeclampsia was more likely to be diagnosed in living kidney donors than in matched non donors with similar indicators of baseline health (incidence, 11% vs. 5%).
*Other important maternal and fetal outcomes did not differ significantly between the two groups, and there were no maternal or perinatal deaths.
* Most women had uncomplicated pregnancies after kidney donation.
*Two previous studies have examined pregnancy outcomes after living kidney donation: a national study conducted in Norway and a single-center study conducted in Minnesota, the incidences of gestational hypertension, preeclampsia, and other maternal and fetal outcomes
after donation in these studies were similar to the estimates in this study
# The strengths of the study:
*A manual review of all perioperative donor charts.
*Careful selection of similar donors and non donors.
*Minimal loss to follow-up (<4%).
*The study population had access to a system of universal health care benefits, in which all health care encounters were recorded.
# The limitations.
*Data with respect to BP, renal function, BMI, and medication use during pregnancy were not available in our data sources.
*Accurate racial information was not available.
* Confidence intervals for risk estimates were wide.
* Physicians use clinical judgment when applying accepted diagnostic criteria for gestational hypertension and preeclampsia, and not all diagnoses have the same medical significance.
# Conclusions
Gestational hypertension or preeclampsia was more likely to be diagnosed in kidney
donors than in matched non donors with similar indicators of baseline health.
# Will this article change your practice?
*The young female donor should be counseled about in spite of the post donation pregnancy associated with elevated risk of gestational HTN or pre- eclampsia, the probabilities of the most serious maternal and fetal outcomes remain low and are not significantly increased after donation.
*There were no significant differences between donors and non donors with respect to rates of preterm birth or low birth weight and there were no reports of maternal death, stillbirth, or neonatal death among the donors. Most women had uncomplicated pregnancies after donation.
Summary:
This study evaluate the risk gestational hypertension and preeclampsia following kidney donation.
Retrospective cohort study of living kidney donors.
85 women (131 pregnancies after cohort entry) were matched in a 1:6 ratio with 510 healthy non-donors from the general population (788 pregnancies after cohort entry). Kidney donations occurred between 1992 and 2009 in Ontario, Canada.
Follow-up through linked health care databases until March 2013.
Donors and non-donors were matched for age, year of cohort entry, residency, income, number of pregnancies before cohort entry, and the time to the first pregnancy after cohort entry.
The primary outcome was a hospital diagnosis of gestational hypertension or preeclampsia.
Secondary outcomes were each component of the primary outcome examined separately and other maternal and fetal outcomes.
Gestational hypertension or preeclampsia was more common among living kidney donors than among non-donors.
Hospital diagnosis of gestational hypertension or preeclampsia were more common in donors.
There were no significant differences between donors and non-donors with respect to rates of preterm birth or low birth weight.
There were no reports of maternal death, stillbirth, or neonatal death among the donors. Most women had uncomplicated pregnancies after donation.
Gestational hypertension or preeclampsia was more likely diagnosed in kidney donors than in matched non-donors with similar baseline health indicators.
How did they reach this conclusion?
By comparing donors to matched non-donors.
Will this article change your practice?
Donors who do not complete their family should be informed about the risk of gestational HTN and pre eclampsia.
Summary : Gestational hypertension and pre-eclampsia in living kidney donors
This article aims to express if there is an increased risk of gestational hypertension and pre-eclampsia in live kidney donors in comparison with matched non donors. Previous studies indicated that there were was no special risk of gestational hypertension or pregnancy complications in those who donate kidney. However, recent studies are reaching a different conclusion, wherein a higher risk of both gestational hypertension and pre-eclampsia is seen in pregnancies after kidney donation in comparison with pregnancies before kidney donation.
The study included women who had at least one previous pregnancy that had reached a minimum gestation of 20 weeks or 5 months. In addition, the study excluded women who had experienced gestational hypertension or pre-eclampsia in their previous pregnancies.
Follow up was long, and done until the women died, migrated to a different place or up to the end of the observation period, i.e., the year 2013.
Limitations of the study :
Strengths of the study :
The study concluded that gestational hypertension and pre-eclampsia were more likely to be diagnosed in donors than non-donors. This can skew the results towards making it appear that kidney donors have higher risk of complications future pregnancies.
The risk of significant complications in the future pregnancies of live kidney donors was concluded to be low.
Reaching the conclusion
The long follow up period, good sample size, thorough interpretation of available data, categorical representation of outcomes for each age group, analysis of previous studies in the same concept all helped in reaching the conclusion.
Changes in practice
Counseling especially regarding pre-eclampsia and gestational hypertension would be something that would be added to my practice. I would specially disillusion patients of the various misinformation regarding complicated pregnancies following kidney donation. This will be a major step towards alleviating any potential concerns of female donors in the reproductive age groups.
In addition, I would encourage donors to plan their pregnancies following donation, and also record BP, BMI, medication use, and kidney function results. Follow up will be maintained for a longer period.
Gestational Hypertension and Preeclampsia in Living Kidney Donors.
Aim of this study is to determine whether donors have a higher risk of gestational hypertension or preeclampsia than do non-donors with similar indicators of baseline health, maternal and fetal outcomes.
Method:
A retrospective, matched-cohort study using linked health care databases in Ontario, Canada until March 2013, all women who donated a kidney between July 1, 1992, and April 30, 2010, in Ontario and who had at least one pregnancy with a gestation of at least 20 weeks during follow-up, involving 85 women (131 pregnancies after cohort entry) who were matched in a 1:6 ratio with 510 healthy non-donors from the general population (788 pregnancies after cohort entry).
Study Outcomes.
=Gestational hypertension or preeclampsia (the primary outcome) was diagnosed in 53 women (15 donors and 38 non-donors).
=The risk was higher among donors than among non-donors specially those who older than 32 years.
= Each component of the primary outcome was also more common among donors than non-donors.
=There were no differ significantly with respect to other secondary maternal or fetal outcomes.
= There were no maternal deaths, stillbirths, or neonatal deaths in either.
Strengths.
– Selection of similar donors and non-donors.
– Minimal loss to follow-up (<4%).
– High levels of health surveillance.
Limitations.
-Data during pregnancy as (blood pressure, renal function & body-mass index) were not available in our data sources.
– Accurate racial information was not available.
Conclusion:
Gestational hypertension or preeclampsia was more common among living kidney donors than among non-donors.
So our potential female donors in child-bearing period should be well oriented about this points and strict follow up for these groups should be done .
Our study and others show that probabilities of the most serious maternal and fetal outcomes remain low and are not significantly increased after donation which might be due to quality of health care.
Will this article change your practice?
This article will keep us so cautious with this group of young females looking for kidney donation and should be counselled about these points that they have risk for developing Gestational HTN and pre-eclampsia.
This is a retrospective cohort study performed at five hospital centers in Ontario between 1992 and 2009 with a follow-up performed in 2013 evaluating gestational hypertension and preeclampsia in living kidney donors.
The drop in glomerular filtration rate after nephrectomy can be as high as 35%, increasing the later risk of developing preeclampsia in women who become pregnant. The groups evaluated in the study (including the control) were screened and had similar characteristics. The main objective is to evaluate gestational hypertension or preeclampsia from 20 weeks of gestation to 12 weeks after birth.
The risk of developing preeclampsia is higher in older women (over 32 years old) and in the first two years after nephrectomy. Most donors (65%) were first-degree relatives, with an OR 2.5 for gestational hypertension and an OR 2.4 for pre-eclampsia.
Despite previous studies, this one presents an excellent comparison between groups, minimal loss in follow-up, and complete perioperative evaluation. Data such as blood pressure, kidney function, BMI and medications were limited. Confidence intervals were high. Genetic predisposition cannot be assessed. This study suggests that the risk of pre-eclampsia is high and should be part of pre-donation counseling for potential kidney donors with a desire for later pregnancy.
I believe that pre-donation counseling should consider and expose the risks for the woman of childbearing age, being aware of the risks involved and the need to consider a high-risk pregnancy.
Gestational hypertension or preeclampsia was more common among living kidney donors than among nondonors (11% vs. 5%)
· the majority of living kidney donors are women, and they ask about if donation may affect future pregnancies
· As there was a debate about affection of donation on future pregnancies, the author conducted this study to determine whether donors have a higher risk of gestational hypertension or preeclampsia than do nondonors with similar indicators of baseline health
Methods
Study Design
· a retrospective, matched-cohort study using linked health care databases in Ontario, Canada, where citizens have universal access to hospital care and physician services
· The data were analyzed by personnel at the Institute for Clinical Evaluative Sciences.
Data Sources
· Information was obtained from four linked data-bases.
· The Trillium Gift of Life Network captures information on all living kidney donors in Ontario
· the perioperative medical charts of all persons who underwent donor nephrectomy at five major transplantation centers in Ontario from 1992 through 2010, were reviewed manually
· Data were complete for all variables in this study except the surgical technique used for nephrectomy (open or laparoscopic), which was missing for 14% of donors and was reported only for patients with complete data
Population
Donors
Inclusion: all women who donated a kidney between July 1, 1992, and April 30, 2010, in Ontario and who had at least one pregnancy with a gestation of at least 20 weeks during follow-up
Nondonors
The author randomly assigned a cohort-entry date (simulated nephrectomy date) to all women who were citizens in Ontario, according to the distribution of cohort-entry dates among donors (July 1, 1992, to April 30, 2010)
Inclusion: women with an age that was within the minimum and maximum ages of donors on their cohort entry date and who had evidence of at least one pregnancy carried to 20 weeks of gestation in follow-up (731,823 women).
women who had visited a physician at least once during the previous 2 years
Exclusion: women with a known medical condition before cohort entry that could preclude donation
Study Outcomes
· Women were followed until death, emigration from the province, or the end of the observation period (March 31, 2013)
· The primary outcome was a hospital-based diagnostic code for either gestational hypertension or preeclampsia
· The number of eclampsia events was anticipated to be small, and to comply with privacy regulations, such events were categorized as preeclampsia
Statistical Analysis
· The author used generalized linear models with generalized estimating equations for the correlation structure to compare the characteristics of donors and nondonors at the time of cohort entry
· Pregnancy characteristics and outcomes were analyzed with the use of generalized linear mixed models with a random intercept and random-effects logistic-regression models
· They repeated the analysis of the primary outcome in three pre-specified subgroups, which were defined on the basis of the presence or absence of at least one pregnancy before cohort entry
· All analyses were performed with the use of SAS software, version 9.3 (SAS Institute)
Results
Observation Time
· 595 women (85 kidney donors and 510 nondonors) were followed for a median of 10.9 years, with a maximum follow-up of 20.0 years
· The last donation occurred in December 2009, and the last childbirth in December 2012
Characteristics of the Study Participants
· In the two study groups, the median age was 29 years, and 29% of the women had at least one pregnancy before cohort entry
· Most donors (65%) were first-degree relatives (sibling, parent, or child) of the recipient, followed by distant relatives or genetically unrelated donors (20%) and spouses (15%)
· Before donation, the median serum creatinine level was 0.76 mg per dL, and the median eGFR was 114 ml per minute per 1.73 m2 of body-surface area
Pregnancies
· The deliveries for all 919 follow-up pregnancies (131 donor pregnancies and 788 nondonor pregnancies) were performed in hospitals (at 100 sites in Ontario)
· The number of previous pregnancies and the interval between pregnancies were similar in the two groups.
Study Outcomes
· Gestational hypertension or preeclampsia (the primary outcome) was diagnosed in 53 women (15 donors and 38 nondonors) at 28 hospitals
· The risk of this outcome was higher among donors than among nondonors (11% vs. 5%)
· The two groups did not differ significantly with respect to other secondary maternal or fetal outcomes.
Subgroup and Additional Analyses
· In subgroup analyses, the odds ratio for the primary outcome in donors as compared with non-donors was significantly higher among women who were older than 32 years of age than among those who were 32 years of age or younger
· among both donors and nondonors, gestational hypertension or preeclampsia was as[1]sociated with an increased likelihood of cesarean section or low birth weight
Discussion
· The strengths of the study include a manual review of all perioperative donor charts, careful selection of similar donors and nondonors, and minimal loss to follow-up (<4%). Our study population had access to a system of universal health care benefits, in which all health care encounters were recorded, and the pregnancies of donors and nondonors had similarly high levels of health surveillance (with medians of 10 prenatal visits and 3 ultrasonographic examination>4%)
· The study population had access to a system of universal health care benefits, in which all health care encounters were recorded, and the pregnancies of donors and nondonors had similarly high levels of health surveillance
Limitations of the study:
1. data with respect to blood pressure, renal function, body-mass index, and medication use during pregnancy were not available in the data sources.
2. accurate racial information was not available
3. confidence intervals for risk estimates were wide.
4. physicians use clinical judgment when applying accepted diagnostic criteria for gestational hypertension and preeclampsia, and not all diagnoses have the same medical significance
· some donors may have had a genetic predisposition to kidney disease, which could have increased the risk of the primary study outcome among those in whom this condition developed.
· Sixty-five percent of the donors had a first-degree relative with kidney failure, and it could be that few nondonors had a similar family history
· This study and others show that probabilities of the most serious maternal and fetal outcomes remain low and are not significantly increased after donation
How did they reach this conclusion?
A comparison between well matched to group, followed for a long time, and good data interpretation
Will this article change your practice?
Actually, I almost always refuse young females to donate. I prefer after she get married and pregnancy. After that if she wishes to donate, I will accept her. Now I just will add on the risk of pre-eclampsia during counselling.
Gestational Hypertension or preeclampsia more common among LKD versus non donor
· Odds ratio for Gestational Hypertension for Donors: 2.5
· Odds ratio for Preeclampsia for donors: 2.4
· Preterm Births: 8% versus 7%
· Low Birth weight: 6% versus 4%
· Maternal deaths, stillbirth or neonatal death not seen in donors
This study concluded that incidence of Gestation Hypertension or Preeclampsia is greater in LRKD and a potential childbearing age women as donor be well informed about the risk of donation. However, few studies found no difference in gestation hypertension/preeclampsia in donors compared to donors
Limitations:
· Missing data regarding BP, KFTs, medication use during pregnancy
· Accurate racial information missing
· Gestational Hypertension and Preeclampsia more likely to be diagnosed in donor due to Physician bias towards Donors
They compared 2 groups in a ratio of 1:6 with respective to their age and demographic characters
Will this article change your practice?
Young Females who at childbearing age should be counselled regarding higher risks of Gestational Hypertension and preeclampsia, however, emotional ties with the recipient tends to overcome the risk and most donor will take the small risk to make the recipient have a good life
Aim of the study:
To evaluate the risk gestational hypertension and preeclampsia following kidney donation
Methods:
A retrospective cohort study of living kidney donors.
85 women (131 pregnancies after cohort entry) were matched in a 1:6 ratio with 510 healthy non-donors from the general population (788 pregnancies after cohort entry). Kidney donations occurred between 1992 and 2009 in Ontario, Canada.
Follow-up through linked health care databases until March 2013.
Donors and non-donors were matched for age, year of cohort entry, residency, income, number of pregnancies before cohort entry, and the time to the first pregnancy after cohort entry.
The primary outcome was a hospital diagnosis of gestational hypertension or preeclampsia.
Secondary outcomes were each component of the primary outcome examined separately and other maternal and fetal outcomes.
Results:
Gestational hypertension or preeclampsia was more common among living kidney donors than among non-donors.
Hospital diagnosis of gestational hypertension or preeclampsia were more common in donors.
There were no significant differences between donors and non-donors with respect to rates of preterm birth or low birth weight.
There were no reports of maternal death, stillbirth, or neonatal death among the donors. Most women had uncomplicated pregnancies after donation.
Conclusion:
Gestational hypertension or preeclampsia was more likely diagnosed in kidney donors than in matched non-donors with similar baseline health indicators.
By comparing donors to well-matched non-donors at a rate of 1:6
Donors who did not complete their families should be informed about the risk of gestational HTN and pre-eclampsia
Please summarize this article in your own words
Primary aim of study: Evaluate likelihood of Gestational Hypertension or Preeclampsia in Donor compared to matched nondonors
Secondary aim:
To find out
1. Risk of Gestational Hypertension and Preeclampsia in donors versus matched nondonors
2. Maternal and fetal outcomes among groups
Matching done with respect:
· Age,
· Years of cohort entry,
· Urban or Rural
· Residency,
· Socioeconomic status,
· Number of pregnancies before cohort entry and time of first pregnancy after cohort entry
Matching Ratio: 1:6
Results:
· Gestational Hypertension or preeclampsia more come among living kidney donor than nondonors
· Odds ratio for Gestational Hypertension for Donors: 2.5
· Odds ratio for Preeclampsia for donors: 2.4
· Preterm Births: 8% versus 7% (Donors versus Non-Donors)
· Low Birth weight: 6% versus 4% (Donors versus Non-Donors)
· Maternal deaths, stillbirth or neonatal death not seen in donors
This study concluded that incidence of Gestation Hypertension or Preeclampsia is greater in Living related kidney donor and a potential childbearing age women as donor be well informed about the risk of donation.
Previous few studies found no difference in gestation hypertension/preeclampsia in donors compared to donors
Strength of study:
Careful matching of cases versus controls and minimal loss to follow-up (<4%)
Limitations:
· Missing data regarding BP, KFTs, medication use during pregnancy
· Accurate racial information missing
· Gestational Hypertension and Preeclampsia more likely to be diagnosed in donor due to Physician bias towards Donors
How did they reach this conclusion?
Careful matching in 1:6 ratio of Donor versus non donor females prospectively helps them to reach the conclusion.
Will this article change your practice?
Young Females must be counselled regarding higher risks of Gestational Hypertension and preeclampsia if selected as potential donor.
However, emotional ties with the recipient (either father/mother/brother or sister) tends to overcome even documented future risks explained to young female donors
Pregnancy with its all possible complications is a major concern in young women wishing to become living kidney donors.
This retrospective cohort study of living kidney donors involving 85 women (131 pregnancies after cohort entry) who were matched in a 1:6 ratio with 510 healthy nondonors from the general population .
The primary outcome was a hospital diagnosis of gestaÂtional hypertension or preeclampsia. Secondary outcomes were each component of the primary outcome examined separately and other maternal and fetal outcomes.
*Results
-It was found that gestational hypertension or preeclampsia was more common among living kidney donors than among nondonors
-Each component of the primary outcome was also more common among donors ,2.5 for gestational hypertension and 2.4 for preeclampsia.
-There were no significant differences between donors and nondonors with respect to rates of preterm birth or low birth weight .
– There were no reports of maternal death, stillbirth, or neonatal death among the donors. Most women had uncomplicated pregnancies after donation.
*limitations of thd study
-data with respect to blood pressure, renal function, body-mass index, and medication use during pregnancy were not available.
– accurate racial information was not availab although 71% of Ontario citizens are white,HyperÂtension after kidney donation is more common among black donors than among white doÂnors.
-physicians use clinical judgment when applying accepted diagnostic criteria for gestational hypertension and preeclampsia.
-Urine protein may rise after nephrectomy,which could also inÂcrease the chance of a diagnosis of preeclampsia among donors.
– some donors may have had a genetic predisposition to kidney disease, which could have increased the risk of primary study outcome .
-Sixty-five percent of the donors had a first-degree relative with kidney failure.
*Will this article change your practice
Young ladies wish to become a living donor must be counseled carefully about possible complications in next pregnancies and the potential risks of hypertension and preeclampsia, beside other long term risks of donation
Full evaluation including family history of kidney disease.
– The aim of this study is to answer the question of young women wishing to become living kidney donors about the effect of donation on her future pregnancies.
– By Comparing 85 female live kidney donors with 510 live healthy matched female non donors.
– follow up for a median period of 10.9 years.
– There were 131 pregnancies in the donors and 788 pregnancies in the control group.
– The primary outcome was diagnosis of gestational hypertension or preeclampsia.
– There are two times higher risk of gestational hypertension (11% VS 5%) and pre eclampsia in live donors as compared to non donors.
– All pregnancies had no complications
– Rate of preterm and low birth weight were similar in two groups
– No maternal mortality, stillbirth or neonatal death was observed.
Conclusion :
– there is a risk for kidney donors to develop gestational HTN or pre eclampsia than the non donors but the possibility of serious maternal and fetal outcome is very low .
>>>this study is encouraging & compatible with the ongoing general concept for increasing the pool for living donation , so such young female can be considered as a candidate for donation with explanation of these low risks on her future pregnancies
Introduction
Each year more than 2700 persons become living kidney donors, and the majority are women. In late pregnancy, animals that have undergone nephrectomy have higher levels of blood pressure and urinary protein excretion than control animals with two kidneys. After donor nephrectomy, GFR drops by 35%. Women with similar losses have an increased risk of Pre-eclampsia. Prior studies comparing the incidence of non-gestational HTN in living donors to nondonors showed inconsistent results and young female donors frequently ask whether kidney donation will affect future pregnancies. A prominent 2004 international conference concluded that kidney donation poses no risk with respect to future pregnancies However, two subsequent studies, one from Norway and the other from the United States, showed an increased risk of gestational hypertension and preeclampsia in pregnancies after kidney donation, as compared with pregnancies before donation.
Aim of the Study
To detect whether female donors have a higher risk of gestational hypertension or preeclampsia than do nondonors with similar indicators of baseline health inclusion and Exclusion Criteria.
Methods
This is a retrospective, well-matched cohort study (Ontario, Canada) Data were obtained from four linked databases in five major transplantation centers in Ontario from 1992 through 2010. Total of 85 women with 131pregnancies matched to the healthy nondonor group of > 500 in the ratio of 1/6. Statistics were complete for all variables except the surgery method (open or laparoscopic) which was absent in 14% of patients
Median fu time 10.9 years.
Inclusion criteria
All women donated kidneys between July 1, 1992, and April 30, 2010, in Ontario and who had at least one pregnancy at the gestational age of 20 wks. and above during follow-up.
Matched to donors (a similarly healthy segment of the general population)
The cohort entry date was randomly assigned according to the Distribution of Donors entry date. The cohort entry date is by the nephrectomy date Women with age within the minimum and maximum age of donors.
Exclusion criteria
All women with a previous history of GHT or preeclampsia in the < 5 years.
Setting:
Well-matched patient characteristics between the two groups by age, year of cohort entry, residency (urban or rural),
income, number of pregnancies before cohort entry, and the time to the first pregnancy after cohort entry date.
Women were followed until death, emigration from the province, or the end of the observation period (March 31, 2013).
Primary Outcome:
hospital-based diagnostic code for either gestational hypertension or preeclampsia (from20 weeks of gestation to 12 weeks after birth)
Eclampsia was Categorized in the study as Pre-Eclampsia for privacy matters (since incidence is very low).
All analyses were performed with the use of SAS software, version 9.3 (SAS Institute).
Results
Gestational hypertension or preeclampsia (the primary outcome) was diagnosed in 53 women (15 donors and 38 nondonors) at 28 hospitals
(Table 3). The risk of this outcome was higher among donors than among nondonors (11% vs. 5%; odds ratio for donors, 2.4; 95% confidence
interval [CI], 1.2 to 5.0; P = 0.01). Each component of the primary outcome was also more common among donors (odds ratio, 2.5 for gestational hypertension and 2.4 for preeclampsia). The two groups did not differ significantly with respect to other secondary maternal or fetal outcomes. There were no maternal deaths, stillbirths, or neonatal deaths in either group.
Discussion
Gestational hypertension or preeclampsia was more diagnosed in living kidney donors than in matched nondonors with similar indicators of baseline health
Maternal and fetal outcomes did not differ significantly between the two groups.
In subgroup analyses, the odds ratio for the primary outcome in donors as compared with nondonors was significantly higher among women who were older than 32 years of age than among those who were 32 years of age or younger (P = 0.004 for interaction) (Fig. 1). Results were similar to the studies done in Norway and Minnesota. In the two previous studies, the analyses compared outcomes in a group of women who were pregnant before donation with outcomes in a group of women who were pregnant after donation.
Strength of the study
Careful selection and matching of donors and non-donors cohorts.
All pregnancies of donors and nondonors had similarly high levels of health follow-up (with medians of 10 prenatal visits and 3 ultrasonographic examinations).
Limitation
1.Retrospective study, a small sample size with wide confidence intervals for risk estimates
2.65% percent of the donors had a first-degree relative with kidney failure or any additional genetic factors.
3. Missing of important data like Renal Parameters, BP, BMI, and Race (this study was limited to the white population.
4. Medications during pregnancy were not available.
5. Doctors use clinical judgment when applying accepted diagnostic criteria for gestational hypertension and preeclampsia, and not all diagnoses have the same medical significance
Conclusion
Gestational hypertension or preeclampsia was more common among living kidney donors than among nondonors with no significant difference in other secondary maternal or fetal outcomes.
Applicability
According to the results from this limited study, I will reconsider donor selection criteria to discuss in detail the possible future risk of preeclampsia and GHT for every young female donor and assess her associated other risk predictors like BMI, FH of CKD, DM, and GD , smoking dyslipidemia the age at the time of donation and we need more studies in prospective design with longer Follow up to address such hard outcome .
The article is about young female donors who are willing to donate a kidney and are showing or posing questions regarding the future if it will affect their reproductive system that is the possibility of getting pregnant.
Now based on this new question, a study was conducted at Ontario Canada from a period of 1992 to 2009. The outcome from the hospital was the diagnosis of Gestational HTN and pre-eclampsia.
The result obtained from the study was that there is an increase chance that kidney donors are more likely to develop Gestational HTN and pre-eclampsia when compare to non-donors.
Also, it was observed that there was not serious maternal –fetal complications post transplantation and never significantly increased.
Some of the positive found in the study are:
1) Manual review of all donors before procedure
2) There was an excellent selection between donors and non-donors
3) And the follow ups were acceptable.
Some of the negative factors found are:
1) The data was focus on BP, renal function BMI and medications taken during pregnancy was not involved.
2) Racial information was not adequately mentioned
3) The diagnosis of gestational HTN and pre-eclampsia was based on clinical assessment.
It was based on the extensive follow-ups of the female donors at the hospital with gestational HTN and PRE-eclampsia.
The article I believe had valid points and I believe I will use it to assist in the managing of patient with the gestational HTN and preeclampsia.
Gestational Hypertension and Preeclampsia in Living Kidney Donors
This article is about a retrospective cohort study to see the effect of kidney donation on pregnancy outcomes.
In this study , 85 female live kidney donors were compared with 510 live healthy matched female non donors.
Findings
There two times higher risk of gestational hypertension (11% VS 5%) and pre eclampsia in live donors as compared to non donors.
All pregnancies had no complications
Rate of preterm and low birth weight were similar in two groups
No maternal mortality in live donors
Strength of Study
Good matching between two groups
Manual review of charts
Careful selection of both groups
Excellent follow up like ultrasound and perinatal visits
<4% were lost to follow up
Limitations
Data on hypertension, medication , BMI , renal function was not available on database
Racial information was not available
Wider CI- Confidence interval
Conclusions
One the basis of this study it can be concluded that hypertension and pre eclampsia is more likely to develop in live kidney donors than matched non donors with similar demographics.
Probabilities of serious maternal and fetal outcome is very low after donation.
Effect on clinical practice
On the basis of this study I can educate young female who are potential donors that kidney donation will not have any significant effect on future pregnancies post donation.
1. Please summarise this article in your own words

The effect of kidney donation by a young female on her future pregnancies needs to be evaluated and explained to the donor. This retrospective study was conducted by reviewing data at 5 transplantation centres in Canada by including 85 female donors and comparing them with 510 matched healthy non-donors from the general population. They were followed up for a median period of 10.9 years. There were 131 pregnancies in the donors and 788 pregnancies in the control group. The primary outcome was diagnosis of gestational hypertension or preeclampsia.
Gestational hypertension or preeclampsia was more common in the donors than the control group (11% versus 5%). The odds ratio of gestational hypertension or preeclampsia was more in donors with age more than 32 years. The rates of pre-term birth and low birth weight were similar in the 2 groups. No maternal mortality, stillbirth or neonatal death was observed.
Gestational hypertension and preeclampsia were associated with increased incidence of LSCS and low birth weight baby in both the groups.
So, the study shows that although gestational hypertension and preeclampsia are more likely to be present in renal donors, most of the pregnancy results are uneventful and the probability of poor maternal or fetal outcomes is very low.
2. How did they reach this conclusion?
They reached their conclusions on the basis of detailed manual review of all the data, careful selection of well-matched controls, and a long-term follow-up with minimal loss to follow-up.
3. Will this article change your practice?
In light of this article, a young renal donor can be counselled with more confidence that although pregnancy post-donation is associated with an increased risk of gestational hypertension or pre-eclampsia, the maternal and fetal outcomes are similar to non-donors.
More than 27000 persons worldwide become kidney donor each year and majority are female.Young female donors keen to know whether they can donate.Studies shows conflicting results, some shows increased risk and some shows no risk.
This is retrospective matched cohort study. Obtained data from four linked databases.Women , who donated kidney and who had at least one pregnency of at least 20 weeks gestation.Healthy segment of general population was selected as non donors.
Women were followed up until death, emigration , or the end of the observation periods. The primary endpoint was a hospital base4d diagnostic code for either gestational hypertension or preeclampsia.The number of eclamsia events was small.In multiple birth pregnency maternal outcomes were only once pewr pregnency.. 595 women were followed up for a median 10.9 years.
Gestational hypertension or pre eclampsia was more common among livinfg donors than non donors. B ut there was no significant differences between donors and non donors with respect to rates of pre term birth or low birth weight. Thewre were no reports of maternal deaths, still birth or neonatal death among donors.
They reach this conclusion when they adjusted the control group to be similar to donor group .
So control group was different from general population which may contain a different age women and different number of pregnancies and births
1. Please summarise this article in your own words:
Introduction:
Every year, more than 27,000 persons worldwide become living kidney donors; the majority are women. Young female donors frequently ask whether kidney donation will affect future pregnancies. Studies before were giving inconclusive results.
We conducted this study to determine whether donors have a higher risk of gestational hypertension or preeclampsia than do nondonors with similar indicators of baseline health. We also compared other maternal and fetal outcomes,
Mehods:
Study Design
We conducted a retrospective, matched-cohort study using linked health care databases in Ontario,Canada, where citizens have universal access to hospital care and physician services. It included donors involving 85 women (131 pregnancies after cohort entry) who were matched in a 1:6 ratio with 510 healthy nondonors from the general population (788 pregnancies after cohort entry).
Kidney donations occurred between 1992 and 2009 in Ontario, Canada, with followup through linked health care databases until March 2013.
Results
Gestational hypertension or preeclampsia was more common among living kidney donors than among nondonors (occurring in 15 of 131 pregnancies [11%] vs. 38 of 788 pregnancies [5%]; odds ratio for donors, 2.4 (P = 0.01). Each component of the primary outcome was also more common among donors (odds ratio, 2.5 for gestational hypertension and 2.4 for preeclampsia).
There were no significant differences between donors and nondonors with respect
to rates of preterm birth (8% and 7%, respectively) or low birth weight (6% and 4%, respectively). There were no reports of maternal death, stillbirth, or neonatal death among the donors. Most women had uncomplicated pregnancies after donation.
Conclusion: :
Gestational hypertension or preeclampsia was more likely to be diagnosed in kidney donors than in matched nondonors with similar indicators of baseline health.
Strengths of the study:
The strengths of our study include:
1. A manualreview of all perioperative donor charts,
2. Careful selection of similar donors and nondonors.
3. Minimal loss to follow-up (<4%).
4. Our study population had access to a system of universal health care benefits
5. The pregnancies of donors and nondonors had similarly high
levels of health surveillance,
Limitations of the study:
1. Data with respect to blood pressure, renal function, body-mass index, and medication use during pregnancy were not available in our data sources.
2. Accurate racial information was not available,34 although
3. 71% of Ontario citizens are white, as are approximately 70% of donors.
4. Physicians use clinical judgment when applying accepted diagnostic criteriafor gestational hypertension and pre-eclampsia.
2. How did they reach this conclusion?
They compare the donors with matched group from non donors. Donors and nondonors were matched with respect to age, year of cohort entry, residency (urban or rural), income, number of pregnancies before cohort entry, and the time to the first pregnancy after cohort entry
3. Will this article change your practice?
After this article we need to tell young female about the increased risk and counsel them that the risk is there but it is small and most of pregnancies will pass smoothly.
one of the most frequent question we will face during our work in transplantation center from the female donor is nephrectomy will affect their future pregnancies ??
in this study
results :
Conclusions
this article was a retrospective cohort study that was done in Canada. it revealed the following outcome :
the strengths of this study were :
1- manual review of all peri-operative donor charts.
2- careful selection of donors and non-donors.
3- minimal loss of follow-up. it was less than 4%.
the limitations of this study were :
1- data related to BP, renal functions, BMI and medications during pregnancy were not available.
2- accurate racial information are not available.
3- the confidence intervals for risk estimates were wide.
4- diagnosis was based on clinical judgement
surly YES
retrospective, matched-cohort study in five major transplantation centers in Ontario from 1992 through 2010, conducted to determine whether donors have a higher risk of gestational hypertension or preeclampsia than do non donors with similar indicators of baseline health.
Donors group: all women who donated a kidney between July 1, 1992, and April 30, 2010, who had at least one pregnancy with a gestation of at least 20 weeks during follow-up. (The primary outcome was assessed after 20 weeks of gestation.) Each woman’s nephrectomy date served as her cohort-entry date. To assess new events during follow-up, * excluded women in whom gestational hypertension or preeclampsia had been diagnosed before donation. matched set of Non donors a similarly healthy segment of the general population selected, using restriction and matching. randomly assigned a cohort-entry date (simulated nephrectomy date) nondonors for 85 of 88 study-eligible donors.
Women were followed until death, emigration from the province, or the end of the observation period (March 31, 2013). The primary outcome was a hospital-based diagnostic code for either gestational hypertension or preeclampsia (from 20 weeks of gestation to 12 weeks after birth)
595 women followed (85 kidney donors and 510 nondonors) for a median of 10.9 years (11.0 years for donors and 10.9 years for nondonors), with a maximum follow-up of 20.0 years. Gestational hypertension or preeclampsia (the primary outcome) was diagnosed in 53 women (15 donors and 38 nondonors) at 28 hospitals. The risk of this outcome was higher among donors than among nondonors (11% vs. 5%; odds ratio for donors, 2.4; 95% confidence interval [CI], 1.2 to 5.0; P=0.01). In subgroup analyses, the odds ratio for the primary outcome in donors as compared with nondonors was significantly higher among women who were older than 32 years of age than among those who were 32 years of age or younger (P=0.004 for interaction) .The two groups did not differ significantly with respect to other secondary maternal or fetal outcomes. There were no maternal deaths, stillbirths, or neonatal deaths in either group.
Study limitations:
1. Data with respect to blood pressure, renal function, body-mass index, and medication use during pregnancy were not available in data sources.
2. accurate racial information was not available
3. confidence intervals for risk estimates were wide.
4. physicians use clinical judgment when applying accepted diagnostic criteria for gestational hypertension and preeclampsia, and not all diagnoses have the same medical significance.
· Careful selected/ well Matched control to the donor group
· Follow up for a median of 10.9 years with minimal loss to follow-up (<4%).
· Manual review of all perioperative donor charts
· Study population had access to a system of universal health care benefits, in which all health care encounters and recorded, and the pregnancies of donors and nondonors had similarly high levels of health surveillance
Better counselling for young potential donor who didn’t complete their family yet about the question frequently ask whether kidney donation will affect future pregnancies.
In this retrospective cohort study involve 85 women matched with 510 women from general population
study done in Ontario, Canada, between 1992 and 2009, with follow up till March 2013,
The result of the study found that , gestational HTN and pre eclampsia , are more common in kidney donors among non-donors, 15 pregnanat 0ver 131 develop GH , and pre-eclampsia (11%) vs 38/788 among non-donors. with p value of 0.01.
All componenet of primary out come was more common in donors than non-donors with od ratio of 2.5 for GH and 2.4 for pre-eclampsia .
and found that no significant difference between 2 groups rgarding preterm birth and law birth weight.
No other pregnancy complication were studied in thisretrospective study .
Study involve al, donors who get pregnant between 1992 and 2009 , and non-donor wuth the same area and time through which study are done , including matcehd age group as well non donor at experienced on delivery .
so the study reached outcome by all data collected during this period and by manually reviewing all data with ensure that donor and nondonors werw matched
in our practice this study will provide us for answering of dially question we faced by ladies who wished to donate her kidney to the relatives , so we clarify more the issue based on the results
Please summarise this article in your own words;
1- gestational hypertension or pre-ecalmpsia was developed in 11% versus 5% in matched non-donors.
2- other maternal and fetal outcomes didn’t differ significantly.
3- most women had uncomplicated pregnancies after donation.
1- manual review of all peri-operative donor charts.
2- careful selection of donors and non-donors.
3- minimal loss of follow-up. it was less than 4%.
1- data related to BP, renal functions, BMI and medications during pregnancy were not available.
2- accurate racial information are not available.
3- the confidence intervals for risk estimates were wide.
4- diagnosis was based on clinical judgement.
How did they reach this conclusion?
Will this article change your practice?
Please summarise this article in your own words
Higher number of living donors female make it of concern the risk of donation on future pregnancies.
the cohort retrospective study conducted in Ontario from 1st july 1992- april 30, 2010.
comparing donor to non donor women with same base line characteristics, for the primary out comes (gestation HTN – hypertension after 20 weeks of gestation till 12 weeks after birth) and preeclampsia.
secondary outcomes was any maternal and fetal death , stillbirths.
Results:
There is significant increase in the primary outcomes in donor women, and the significance increased if in first two years, age >32 yrs, ..etc.
There is no increase in maternal or fetal death,cesarean section, postpartum Hg. in both groups and stillbirth were comparable in the two groups.
Limitations:
71% of Ontario population are white.
Blood pressure, renal function, body mass index, urinary proteins and medications during pregnancy data were not available.
The confidence intervals for risk estimates were wide.
The clinician diagnostic bias – clinical judgment when applying the criteria (example proteinuria post nephrectomy).
How did they reach this conclusion?
Comparing donor and non donor women, with comparable variables by analyzing data collected.
Will this article change your practice?
No, because we already discuss this issue with our female donors.
Gestational Hypertension and Preeclampsia in Living Kidney Donors:
It’s retrospective cohort study address risk of gestational hypertension and preeclampsia in living donor and matching it with non donor women in respect to age and previous pregnancy and time of pregnancy post donation and risk of complications during pregnancy.
This study conducted in canada from 1992 to 2010.
Characteristics of living donation and matched with non donor at time of entry cohort study:
In respect of median age of donor and non donor is 29 years and period of cohort entry from 1992 to 2009 which conducted at time of nephrectomy whether by open surgery or laparoscopic.
History of number of previous pregnancies in both donor and non donor and median number of fallow up clinic were observed from entry of cohort study to death or migration.
Characteristics of pregnancy in living donation and matched with non donor at after entry of cohort study:
The most of them get pregnant 2 years after donation
Median age 32 Years for both donor and non donor.
Years of pregnancy observation from 1994 to last pregnancy 2009 and last neonates fallow up 2012.
The pregnancy fallow in clinic from 20 weeks to 12 weeks after delivery with regular visits to clinic and ultrasound examination monitoring.
From observation of this studies and previous studies shows incidence of gestational hypertension and preeclampsia was high in kidney donation in comparison to non donor ; with increase chance of caesarian section and low birth weight; but there is no significant difference in maternal and fetal complications in both donor and non donor.
Risk of gestational hypertension and preeclampsia more in older women > 32 years.
gestational hypertension and preeclampsia were more likely to be diagnosed and recorded among donors than among nondonors despite similar clinical presentations in the two groups. Urine protein may rise after nephrectomy which could also in- crease the chance of a diagnosis of preeclampsia among donors.
Strength of this study is
Manual review of all peri operative chart
Carful selection of donor and no donor
minimal loss of fallow up
All donor and non donor had similar high level of health surveillance.
Limitations of this study is no available data regarding renal function and blood pressure monitoring and no information regarding BMI and medication during pregnancy.
How did they reach this conclusion?
It’s large prospective cohort study with persistent fallow up more than 20 years. and review of many previous studies
There’s one experimental study on animals shows increase incidence of gestational disease and preeclampsia in those with nephrectomy.
3. Will this article change your practice?
Young living donation has genetic predisposition to kidney disease if there’s history of kidney disease in first degree of relative and there’s risk of gestational hypertension and non gestational hypertension during pregnancy . So they need close monitoring of blood pressure and renal function and proteinuria which may increase post donation.
Gestational Hypertension and Preeclampsia in Living Kidney Donors
Summary
This is a retrospective cohort study, conducted in the period from 1992 to 2009 in Ontario, Canada. The primary outcome was the hospital diagnosis of gestational hypertension or pre-eclampsia.
The net results of the study:
1. The kidney donors are more likely to develop Gestational hypertension or pre-eclampsia in comparison to matched nondonors with similar indicators of baseline health.
2. The study showed that probabilities of the most serious maternal and fetal outcomes remain low and are not significantly increased after donation.
The strengths of the study
1. There was a manual review of all perioperative donor charts.
2. The Careful selection of similar donors and nondonors.
3. A minimal loss to follow-up.
Study limitations:
1. First, data with respect to blood pressure, renal function, body-mass index, and medication use during pregnancy were not available in study’s data sources.
2. Accurate racial information was not available(Hyper- tension after kidney donation is more common among black donors than among white donors).
3. The confidence intervals for risk estimates were wide.
4. Physicians use clinical judgment when applying accepted diagnostic criteria for gestational hypertension and preeclampsia.
5. Urine protein may rise after nephrectomy, which could also increase the chance of a diagnosis of preeclampsia among donors.
How did they reach this conclusion?
They reached this conclusion after extensive and detailed follow-up of female kidney donors for the hospital diagnosis of gestational HTN and pre-eclampsia in comparison to matched non-donors.
Will this article change your practice?
1. This article will further encourage me towards counseling the potential female donor in her reproductive age about the risk of donation and the probability of gestational HTN and pre-eclampsia.
I will not discourage potential female donor in her reproductive age from kidney donation provided that she is healthy, willing to donate and have no contraindication to kidney donation.
The aim of the study ;
The primary outcome was a hospital diagnosis of gestational hypertension or preeclampsia.
Secondary outcomes were each component of the primary outcome examined separately and other maternal and fetal outcomes.
The type of the study ;
a retrospective, matched-cohort study using linked health care databases .
The study area ;
Ontario, Canada, where citizens have universal access to hospital care and physician services.
Ethical approval ;
The study was designed by the authors and approved by a regional ethics committee.
Population;
1- Donors;
Inclusion criteria ;
1-All women ,who donated a kidney between July 1, 1992, and April 30, 2010, in Ontario.
2-had at least one pregnancy with a gestation of at least 20 weeks during follow-up.
3-Each woman’s nephrectomy date served as her cohort-entry date.
Exclusion criteria ;
women in whom gestational hypertension or pre-eclampsia had been diagnosed before donation .
2-Non donors;
randomly assigned a cohort-entry date (simulated nephrectomy date) to all women who were citizens in Ontario, according to the distribution of cohort-entry dates among donors (July 1, 1992, to April 30, 2010).
Inclusion criteria ;
1-women with an age that was within the minimum and maximum ages of donors on their cohort entry date .
2- had evidence of at least one pregnancy carried to 20 weeks of gestation in follow-up .
The study of living kidney donors involving 85 women (131 pregnancies after cohort entry) who were matched in a 1:6 ratio with 510 healthy non donors from the general population (788 pregnancies after cohort entry).
Statistical Analysis;
1-generalized linear models was used with generalized estimating equations for the correlation structure to compare the characteristics of donors and non donors at the time of cohort entry.
2- Pregnancy characteristics and outcomes were analyzed with the use of generalized linear mixed models with a random intercept and random-effects logistic-regression models, which account for the correlation structure within matched sets and in women with more than one follow-up pregnancy.
3-All analyses were performed with the use of SAS software, version 9.3 (SAS Institute). Continuous data were summarized as medians and interquartile ranges.
Results;
1-Gestational hypertension or preeclampsia was more common among living kidney donors than among non donors .
2-There were no significant differences between donors and non donors with respect to rates of preterm birth or low birth weight .
3-There were no reports of maternal death, stillbirth, or neonatal death among the donors.
The strengths of the study include;
1-a manual review of all perioperative donor charts.
2-careful selection of similar donors and non donors.
3-population had access to a system of universal health care benefits .
4- the pregnancies of donors and non donors had similarly high levels of health surveillance .
The study limitations;
1-data with respect to blood pressure, renal function, body-mass index, and medication use during pregnancy were not available in our data sources.
2- accurate racial information was not available.
3-confidence intervals for risk estimates were wide.
4- physicians use clinical judgment when applying accepted diagnostic criteria for gestational hypertension and preeclampsia, and not all diagnoses have the same medical significance.
2-How did they reach this conclusion?
1-They reviewed all the evidence and associated limitations.
2- The observation of this study is more than 10 years .
3-Will this article change your practice?
It help us in counseling young female donors .We should provide donors with up-to-date, accurate information about risks (including pregnancy risk) and acknowledge the limitations of what is known.
Summary
This was a study looking at gestational hypertension and preeclampsia in living kidney donors(LKD).
It was a retrospective matched-cohort study using linked health care databases in Ontario.
The preoperative data for all donors was manually reviewed for accuracy at the 5 major transplant centers in Ontario.
The inclusion criteria were all female donors who donated a kidney between July 1992 to April 2012 and who had at least one pregnancy with a gestation of at least 20 weeks during follow up
Women who had a previous history preeclampsia and gestational HTN prior to donation were excluded.
A matched cohort of healthy women who were eligible non-donors were matched to each donor on the basis of baseline characteristics that may be associated with the risk of gestational HTN or preeclampsia. These included
The primary outcome was a hospital based diagnostic code for either gestational HTN or preeclampsia.
595 women were included in the study (85 kidney donors and 510 non-donors) and were followed up for a median of 10.9 years.
Most of the baseline characteristics were similar between the 2 groups except for the median no. of physician visits in the previous year that was higher in the donor group
Gestational HTN or preeclampsia was diagnosed in 58 women – 15 donors and 38 donors. The risk of the primary outcome was higher among donors than non-donors – 11% vs 5%, OR of 2.4
Each component of the primary outcome was also higher among donors – OR 2.5 for GH and 2.4 for preeclampsia.
The 2 groups did not defer significantly in terms of secondary maternal and fetal outcomes.
An older age, increased number of previous pregnancies and a larger time interval from donation to pregnancy increase the risk for the primary outcome in the donor group
The outcomes are similar to the US and Norwegian studies that looked at the same same outcomes.
The study had some limitations
based on this study and the previous studies, it would be important to include the risks of gestational HTN and preeclampsia for the potential female donors in the consent form and counseling sessions for them to make an informed choice
How did they reach this conclusion?
The data showed that gestational hypertension and preeclampsia were significantly higher in the donor group as compared to the matched cohort of healthy eligible non-donors, both when looked at as a composite end point and individually
Will this article change my practice?
Yes, this article will change my practice. More counseling will be done for the young female patients who are nulliparous to explain to them the risks of developing gestational HTN and preeclampsia. This information will also be included in the consent form
1-Summary of Gestational Hypertension and Preeclampsia in Living Kidney Donors
Methods
A retrospective cohort study of living donors for 85 women, kidney donation between 1992 and 2009 in Ontario,Canada with follow up until march 2013.
donors and donors were matched with respect to age ,year of cohort entry ,residency, income ,number of pregnancies’ before cohort entry and the time to firs pregnancy after cohort entry
primary outcome was a hospital diagnosis of gestational HTN or preeclampsia.
results
Gestational HTN or preeclampsia was more common among living kidney donors than non donors11%
preterm birth there were no significant differences between donors and nondonors .
no reports of maternal death, stillbirth or neonatal death among donors.
Gestational HTN or preeclampsia was more likely to be diagnosed in kidney donors than in matched nondonors.
The aims of this study
To show whether donors have a higher risk of gestational HTN or preeclampsia than do non donors with similar indicators.
Compared maternal and foetal outcomes.
Retrospective matched- cohort study
Donors all women from 1/1992 and April30/2010 and who had at least one pregnancy at least 20 weeks during follow up .
Study outcomes
Primary outcome was gestational HTN or preeclampsia from 20 weeks of gestation to 12 weeks after birth
Discussion
In Canadian cohort ,gestational HTN or preeclampsia was more likely to be diagnosed in living kidney donors than in matched nondonors with similar indicators of baseline health(11% vs.5%)
Other important maternal and foetal outcome did not differ significantly between the two groups ,and there were no maternal or perinatal death .most women had uncomplicated pregnancies after kidney donation.
Strength of the study:
Manual of all perioperative donor charts
Careful selection of similar donors and nondonors
Minimal loss to follow up,4%.
Limitation of this study
Some data not available such as:Bp,renal function ,BMI and medication use during pregnancy .
Accurate racial information was not available .
70%of donors are white.
Wide confident interval for risk estimation.
An increased risk of gestational hypertension and preeclampsia among kidney donors is biological plausible.
The study showed maternal and fetal outcomes remain low and not increased after donation
2- conclusion reach through this study which matched donors and non donors women .
3-this will change our practice to add this information when taking consent for donation but handle this information in way that will not affect donor pool
SUMMARY:
Introduction:
Out of the estimated number of global donors annually, women have been found to constitutes a larger proportion and this comes with dominant concern on the implication donating kidney for their future pregnancies and health. Also, many studies on this concern have come up with conflicting conclusions.
Aim of the study:
Methods
Statistical analysis:
Result:
Strength of the study
Limitation of the study
The conclusion was reached because of the following:
Yes, this study is an eye opener to be more selective in the choice of young woman as a donor. I work in a center where our transplant program is still young, hence we can start to envisage the possible challenges that may arise in some years to come among young women donors.
Female being the donor in majority of renal transplant cases, had main renal concern about the fertility issues, because of 35% decrease in GFR after donation and as this decrease in other etiologies other than donation leads to more chances of preeclampsia. This study recruited 85 LKD women matched in a 1:6 ratio with 510 healthy non donors . and followed up for a median of 10.9 years (11.0 years for donors and 10.9 years for non donors). The study revealed gestational hypertension or preeclampsia was diagnosed in 53 women (15 donors and 38 non-donors) with the risk higher among donors than non donors (11% vs. 5%).Proteinuria may be increased in few cases post donation. No maternal and fetal mortality seen in any group. Pitfalls of the study includes detailed demographic data and detailed history of patient before donation missing and few more important points need to be considered i.e., may be some patients more prone to develop kidney disease due to presence of renal disease in family or more prone due to genetic predisposition.
Will this article change your practice?
Definitely , it will change my practice and now counseling and education of the female donors about the maternal)and fetal outcome will be part of my management strategy and will also tell them about the chances of gestational hypertension and preeclampsia is less and they can have a healthy baby later
Young female donors frequently ask whether kidney donation will affect future pregnancies. Data about the risk of gestational hypertension and preeclampsia in pregnancies after kidney donation have been debated.
Aim of the study:
Determine whether donors have a higher risk of gestational hypertension or preeclampsia than nondonors and compare other maternal and fetal outcomes.
Study Design:
Retrospective, cohort study
Study population:
-Included all 85 women who donated a kidney between July 1, 1992, and April 30, 2010, in Ontario and who had at least one pregnancy with a gestation of at least 20 weeks during follow-up (131 pregnancies after cohort entry).
-Matched in a 1:6 ratio with 510 healthy nondonors from the general population (788 pregnancies after cohort entry).
Excluded women in whom gestational hypertension or preeclampsia had been diagnosed before donation, women with the same medical condition were excluded from non-donor group.
Study Outcomes:
The primary outcome was a hospital diagnosis of gestational hypertension or preeclampsia.
Secondary outcomes were each component of the primary outcome examined separately and other maternal and fetal outcomes.
Results
– Gestational hypertension or preeclampsia was more common among living kidney donors than among nondonors 11% vs. 5%; the odds ratio for donors, 2.4
– Each component of the primary outcome was also more common among donors :
Odds ratio, 2.5 for gestational hypertension
OR 2.4 for preeclampsia).
– There were no significant differences between donors and nondonors concerning:
Preterm birth rates (8% and 7%, respectively) or low birth weight (6% and 4%, respectively).
– There were no reports of maternal death, stillbirth, or neonatal death among the donors.
Most women had uncomplicated pregnancies after donation.
Conclusions
Gestational hypertension or preeclampsia was more likely to be diagnosed in kidney donors than in matched nondonors with similar baseline health indicators.
The strengths of the study:
– Manual review of all perioperative donor charts
– Careful selection of similar donors and nondonors.
– Minimal loss to follow-up (<4%).
– Study population had access to a system in which all health care encounters were recorded.
– The pregnancies of donors and nondonors had similarly high levels of health surveillance
limitations.
– Data concerning blood pressure, renal function, BMI, and medication use during pregnancy were not available in our data sources.
– Accurate racial information was not available
– confidence intervals for risk estimates were wide
– physicians use clinical judgment when applying accepted diagnostic criteria for gestational hypertension and preeclampsia.
– Urine protein may rise after nephrectomy, which could also increase the chance of diagnosing preeclampsia among donors.
– Sixty-five percent of the donors had a first-degree relative with kidney failure. Some donors may have had a genetic predisposition to kidney disease, which could have increased the risk of the outcome
The conclusion of Careful matching between donor and non-donor with similar characteristics, matching 1:6
Yes, this study answered very an important question among female donors. Donors need to be counselled about the small risk of developing gestational hypertension and preeclampsia in future pregnancies. However; they need to be encourage to as most pregnancies are uneventful which will increase the donor pool.
Please summarise this article in your own words
This is a retrospective cohort study of LKDs.
It involved 85 women (131 pregnancies); they were matched in a 1:6 ratio with 510 healthy non-donors from the general population (788 pregnancies).
Donors
All women who donated a kidney from July 1, 1992, & April 30, 2010, & had at least one pregnancy with a gestation of at least 20 weeks during follow-up; primary outcome was assessed after 20 weeks of gestation. The cohort entery date is the nephrectomy date.
Nondonors
Healthy women selected from the general population, using restriction & matching (for age, year of cohort entry, residency, income, number of pregnancies before cohort entry, & time to the 1stpregnancy after cohort entry).
primary outcomes were the hospital diagnosis of gestational HTN and preeclamsia
secondary outcomes were related maternal and fatal complications
GH or preeclampsia more common among LKDs compared to non-donors(15 of 131 pregnancies [11%] vs. 38 of 788 pregnancies [5%]; OR, 2.4; 95% CI, 1.2 to 5.0; P = 0.01).
Each component examined separately was also more common among donors (OR, 2.5 for GH & 2.4 for preeclampsia).
Rates of preterm birth (8% & 7%, respectively) or low birth weight (6% & 4%, respectively) were not significantly different between donors & non-donors.
No reports of maternal death, stillbirth, or neonatal death among the donors.
Most women had uncomplicated pregnancies after donation
A lot of limitation like patient RFT ,their way of management ,BMI and racial background
Conclusions:
Gestational hypertension or preeclampsia was more likely to be diagnosed in kidney donors than in matched nondonors with similar indicators of baseline health.
Think this is will add to our practice as we will raise this issue with young donors who they want start they family .
1.Please summarise this article in your own words
This is a retrospective cohort study of LKDs.
It involved 85 women (131 pregnancies); they were matched in a 1:6 ratio with 510 healthy non-donors from the general population (788 pregnancies).
Study area:
Ontario, Canada.
Population
Donors
All women who donated a kidney from July 1, 1992, & April 30, 2010, & had at least one pregnancy with a gestation of at least 20 weeks during follow-up; primary outcome was assessed after 20 weeks of gestation. The cohort entery date is the nephrectomy date.
Nondonors
Healthy women selected from the general population, using restriction & matching (for age, year of cohort entry, residency, income, number of pregnancies before cohort entry, & time to the 1stpregnancy after cohort entry).
Primary outcome:
Hospital diagnosis of gestational hypertension (GHÂ) or preeclampsia.
Secondary outcomes:
Each component of the primary outcome examined separately plus other maternal & fetal outcomes.
Results
GH or preeclampsia more common among LKDs compared to non-donors(15 of 131 pregnancies [11%] vs. 38 of 788 pregnancies [5%]; OR, 2.4; 95% CI, 1.2 to 5.0; P = 0.01).
Each component examined separately was also more common among donors (OR, 2.5 for GH & 2.4 for preeclampsia).
Rates of preterm birth (8% & 7%, respectively) or low birth weight (6% & 4%, respectively) were not significantly different between donors & non-donors.
No reports of maternal death, stillbirth, or neonatal death among the donors.
Most women had uncomplicated pregnancies after donation.
Discussion
Two previous studies (Norway, Minnesota) have examined pregnancy outcomes after LKD:
The outcomes in these studies (incidences of GH, preeclampsia, & other maternal fetal outcomes after donation) were similar to the estimates in the current study.
Limitations
No data of BP, renal function, BMI, & medication use during pregnancy.
Accurate racial information not available.
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2.How did they reach this conclusion?
By comparing the primary & secondary outcomes between a cohort of women who donated a kidney & a cohort of healthy women (1:6 ratio) who were carefully selected & matched.
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3.Will this article change your practice?
In our transplant center, we will include the information presented in this article in the counseling & informed-consent processes for woman of reproductive potential who come for kidney donation.