Pregnancy after kidney transplantation: global insights based on registry data from three continents

Abstract

Background: Lack of data regarding pregnancy post-kidney transplantation challenges clinicians who are faced with complex, high-risk cases. Aiming at tackling knowledge gaps and limited cross-cultural data on pregnancy in kidney transplant recipients (KTRs), we compared the methodologies and pregnancy outcomes of three registries based in three continents. Methods: Data were gathered from reports and publications of the Pregnancy After Renal Transplantation OUTcomes registry (PARTOUT, Netherlands), the Australia and New Zealand Dialysis and Transplant Registry (ANZDATA), and the Transplant Pregnancy Registry International (TPRI, United States of America and international). We targeted the similarities and differences among the registries to understand methodological variations. Results: The registries utilized distinct approaches regarding data collection which influence data interpretation. PARTOUT conducted a retrospective analysis of all Dutch pregnant KTRs between 1971 and 2017. ANZDATA includes annual surveys on all KTR parenthood events since 1968. TPRI offers international coverage and includes pregnant KTRs voluntarily registered since 1991. Despite methodological differences, preeclampsia, preterm birth and low birth weight were common pregnancy complications, and outcomes were mostly comparable among the registries. Conclusions: Despite differences in case capture, the three registries reported similar pregnancy and newborn outcomes, confirming that pregnancy in KTRs can be successful with careful monitoring across varying populations. Identifying the strengths and weaknesses of each registry can contribute to improved methodologies for global data collection and lower missing data rates. Although managing large databases may be challenging, aligning data across countries could lead to meaningful data pooling, while identifying drivers of outcomes across subpopulations.