Assisted reproductive technology increases pregnancy risks in women with kidney transplants

Assisted reproductive technology increases pregnancy risks in women with kidney transplants

Women with kidney transplants who use assisted reproductive technology (ART) to conceive may face higher risks of complications during pregnancy, according to new research from the University of Cincinnati College of Medicine. The study provides some of the first large-scale data on pregnancy outcomes in this unique patient population.

Silvi Shah, MD, associate professor in the Division of Nephrology and Hypertension in the Department of Internal Medicine, led the research in collaboration with the Transplant Pregnancy Registry International (TPRI). It was recently published in the Journaltransplantation. The study is among the first of its kind to evaluate the effects of assisted fertility treatments in kidney transplant recipients.

Chronic kidney disease can significantly affect a woman's fertility. While many women regain fertility and are able to conceive naturally after receiving a kidney transplant, some continue to experience infertility and turn to art for help.

“Until now, little was known about the outcomes of pregnancies using assisted reproductive technology in women with kidney transplants,” said Shah, a physician-scientist who also sees patients at UC Health. “Our study provides valuable evidence to guide physicians when counseling patients on family decision-making and the use of assisted reproductive technology.”

Researchers used data from the TPRI to analyze pregnancy outcomes in kidney transplant recipients during the 54-year period between 1968 and 2022. This study focused on 130 artificial pregnancies in 77 kidney transplant recipients across North America and compared them to pregnancies conceived naturally in the same patient population. The artificial methods in the study included fertility drugs, intrauterine insemination (IUI) and in vitro fertilization (IVF).

Shah and colleagues found artificial pregnancies among kidney transplant recipients that were associated with a higher risk of some complications. These included increased rates of high blood pressure during pregnancy, a greater likelihood of cesarean delivery, a higher risk of preterm birth (defined as delivery before 37 weeks' gestation), and lower birth weights in babies.

However, the study found no significant difference in live birth rates or two-year survival between art and natural conceptions - an encouraging sign that art is a viable and ultimately safe option.

For women with kidney transplants, it is safe to pursue ART provided they have stable creatinine levels, optimal immunosuppression, well-controlled blood pressure, and no recent rejection episodes. We now have data showing that while certain risks are higher, outcomes such as long-term kidney function and live birth rates are not negatively affected.

This research is an important step in understanding how best to support kidney transplant recipients considering pregnancy with assisted reproductive technology and improving our ability as physicians to make informed reproductive decisions for patients. “

Silvi Shah, MD, Associate Professor, Division of Nephrology and Hypertension, Department of Internal Medicine, University of Cincinnati College of Medicine

Shah's work helps fill a critical knowledge gap: Although pregnancy in kidney transplant recipients has long been recognized as high-risk, little was known about outcomes with ART.

The research team also included Anthony Leonard, PhD, biostatistician and associate professor of biostatistics, health informatics and data science. Prasoon Verma, MD, assistant professor of pediatrics and neonatologist at Cincinnati Children’s Hospital; and collaborators graduate students Brenna Rachwal, Pragati Basa and Nisha Sheshashayee.

Collaborators from other institutions included Prema Vyas, MD of Texas Christian University; Swati Rao, MD of the University of Virginia; Jonathan Konel, MD, University of Maryland Medical Center; Shilpanjali Jesudason, PhD, University of Adelaide; and Serban Constantinescu, MD, PhD, Michael Moritz, MD and Lisa Coscia from the Transplantation PRANVERSY Registry International – Gift of Life Institute in Philadelphia.

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