Living donation and pregnancy complications: State of the evidence and ‘call-to-action’ for improved risk assessment

Abstract

of donation on future pregnancies as well as the impact of pregnancy complications on postdonation outcomes. In February of 2023, the American Society of Transplantation Women’s Health Community of Practice held a virtual Controversies Conference on reproductive health, contraception and pregnancy after transplantation and living donation. Experts in the field presented the available data. Smaller breakout sessions were created to discuss findings, identify knowledge gaps and develop recommendations. Herein we present the conference findings related to living donation. The evidence reviewed shows that gestational hypertension and gestational diabetes mellitus pre-kidney donation have been associated with an increased risk of developing postdonation hypertension and diabetes mellitus respectively, without increasing the risk of developing an estimated glomerular filtration rate <45 ml/min postdonation. The risk of preeclampsia in living kidney donors increases to 4-10% and low dose aspirin may help reduce that risk. Little is known about the financial burden of living donors that become pregnant, their risk of postpartum depression or the optimal time between donation and conception. The data on living liver donors is even scarcer. The creation of a registry of donor candidates may help answer many of these questions and in turn educate prospective donors so they can make an informed choice. Living kidney and liver donation significantly increase the organ supply to make lifesaving transplant possible, offering a survival advantage to the recipient and cost savings to the society. Of all living donors 40% are women of childbearing age. However limited data exist regarding the impact of donation on future pregnancies as well as the impact of pregnancy complications on postdonation outcomes. In February of 2023, the American Society of Transplantation Women’s Health Community of Practice held a virtual Controversies Conference on reproductive health, contraception and pregnancy after transplantation and living donation. Experts in the field presented the available data. Smaller breakout sessions were created to discuss findings, identify knowledge gaps and develop recommendations. Herein we present the conference findings related to living donation. The evidence reviewed shows that gestational hypertension and gestational diabetes mellitus pre-kidney donation have been associated with an increased risk of developing postdonation hypertension and diabetes mellitus respectively, without increasing the risk of developing an estimated glomerular filtration rate <45 ml/min postdonation. The risk of preeclampsia in living kidney donors increases to 4-10% and low dose aspirin may help reduce that risk. Little is known about the financial burden of living donors that become pregnant, their risk of postpartum depression or the optimal time between donation and conception. The data on living liver donors is even scarcer. The creation of a registry of donor candidates may help answer many of these questions and in turn educate prospective donors so they can make an informed choice. Copyright © 2024 by the American Society of Nephrology...