Article Impact Level: HIGH Data Quality: STRONG Summary of Transplantation. https://doi.org/10.1097/TP.0000000000005449 Dr. Silvi Shah et al.
Points
- This retrospective cohort study analyzed 130 ART pregnancies in 77 kidney transplant recipients, comparing outcomes to those from natural conceptions within an international registry from 1968 to 2022.
- ART pregnancies were linked to a significantly higher adjusted likelihood of hypertension during pregnancy, a greater chance of cesarean delivery, and a nearly twofold increased risk of preterm birth.
- Infants conceived via ART also had a lower median birth weight, a shorter median gestational age, and a demonstrably higher proportion of neonatal deaths compared to the natural conception group.
- Despite these findings, there were no statistically significant differences observed in the rates of live births, miscarriages, preeclampsia, gestational diabetes, or congenital birth defects between the two cohorts.
- Crucially, the data showed that the likelihood of 2-year kidney transplant graft loss was comparable between patients who used ART and those who conceived naturally, supporting its overall safety.
Summary
This retrospective cohort study evaluated pregnancy outcomes in kidney transplant recipients, comparing those who used assisted reproductive technology (ART) with those who conceived naturally. Researchers analyzed data from the Transplant Pregnancy Registry International for eligible recipients who conceived between March 1968 and July 2022. The analysis included 130 pregnancies using ART in 77 recipients, which were compared against a cohort of natural conceptions from the same registry. Logistic regression analyses, adjusted for maternal age at conception and race, were used to determine the likelihood of various maternal and fetal outcomes between the two groups.
The results demonstrated that pregnancies conceived via ART were associated with a statistically significant higher risk for several adverse outcomes. These included a higher adjusted likelihood of hypertension during pregnancy (odds ratio [OR], 1.57; 95% confidence interval [CI], 1.06-2.32), an increased likelihood of cesarean delivery (OR, 1.60; 95% CI, 1.02-2.51), and a substantially higher adjusted risk of preterm birth before 37 weeks’ gestation (OR, 2.07; 95% CI, 1.35-3.18). Furthermore, ART pregnancies had a lower median birth weight (2551 g vs. 2722 g), a lower median gestational age (36.0 weeks vs. 37.0 weeks), and a higher rate of neonatal death (4.4% vs. 0.8%) compared to natural conceptions.
Despite these increased risks, the study found no significant differences in several other critical outcomes. The adjusted likelihood of preeclampsia, gestational diabetes, miscarriage, or congenital birth defects did not differ between the ART and natural conception groups. Crucially, the rates of live births and 2-year allograft loss were also comparable. This research suggests that while ART in kidney transplant recipients requires heightened surveillance for specific complications, it does not negatively impact the ultimate chances of a live birth or short-term graft survival, making it a viable option for carefully selected patients.
Link to the article: https://journals.lww.com/transplantjournal/abstract/9900/pregnancy_outcomes_using_assisted_reproductive.1124.aspx
References Shah, S., Rachwal, B., Vyas, P., Basera, P., Rao, S., Sheshashayee, N., Leonard, A. C., Verma, P., Konel, J., Constantinescu, S., Moritz, M., Jesudason, S., & Coscia, L. A. (2025). Pregnancy outcomes using assisted reproductive technology in kidney transplant recipients. Transplantation. https://doi.org/10.1097/TP.0000000000005449
