Impact of Prior Adverse Pregnancy Outcome on Kidney Structure and Function in Kidney Donors

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Abstract
Key Points: Compared with kidney donors with uncomplicated pregnancies, donors with prior adverse pregnancy events did not have altered kidney structure at donation. Kidney function 10 years after donation was comparable between donors with and without prior adverse pregnancy outcomes. Prior adverse pregnancy outcomes do not translate into subclinical kidney injury in otherwise healthy donor candidates. Background: Hypertensive disorders of pregnancy (HDP), gestational diabetes mellitus (GDM), and preterm delivery are associated with higher long-term cardiovascular, metabolic, and kidney disease risk. Their implications for living kidney donation remain uncertain. Methods: We conducted a retrospective cohort study of 498 female living kidney donors (2000–2017) from the Mayo Clinic Living Donor Program with documented pregnancy histories, predonation computed tomography angiography, implantation kidney biopsy, and measured GFR. Donors with prior HDP ( n =45), GDM ( n =18), or preterm delivery ( n =65) were compared with donors without adverse pregnancy outcomes (APOs; n =385). Kidney morphometry, histology, and function were analyzed with adjustment for age at donation and first pregnancy, parity, and hypertension. Postdonation kidney outcomes were assessed using surveys and medical record review. Results: Donors with prior HDP and GDM had higher body mass index at donation (+7.9% and +8.9%; P = 0.006 and 0.04), whereas donors with preterm delivery had lower body mass index (−4.8%; P = 0.03) compared with donors with no APO. After adjustment, donors with HDP showed no differences in kidney volumes, biopsy features, or kidney function at donation or during follow-up. Donors with GDM had larger total and cortical kidney volumes (9.5%–10%), less arterial luminal stenosis, and higher 5-year postdonation eGFR (+15%; P = 0.03). Donors with preterm delivery had a lower risk of eGFR 2 (hazard ratio, 0.28; P = 0.03). Conclusions: Prior APOs were not associated with adverse kidney structure at donation or accelerated kidney function decline postdonation. These findings support that APO history alone should not preclude living kidney donation when other eligibility criteria are met.
Funding Information
  • Mayo Clinic (Catalyst Award)
  • Center for Clinical and Translational Science, Mayo Clinic (UL1TR002377)
  • National Institute of Diabetes and Digestive and Kidney Diseases (R01 DK090358)
  • Mayo Clinic (Catalyst Award)
  • Center for Clinical and Translational Science, Mayo Clinic (UL1TR002377)
  • National Institute of Diabetes and Digestive and Kidney Diseases (R01 DK090358)

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