University of Cincinnati study explores fertility treatment risks for kidney transplant recipients

(Press-News.org) Women with kidney transplants who use assisted reproductive technology (ART) to conceive might 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 journal Transplantation. 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 impair a woman’s fertility. While many women regain fertility after receiving a kidney transplant and are able to conceive naturally, some continue to experience infertility and turn to ART for help.

“Until now, little has been 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 toward family-planning 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 ART pregnancies in 77 kidney transplant recipients across North America and compared them to pregnancies conceived naturally in the same patient population. ART methods in the study included fertility medications, intrauterine insemination (IUI) and in vitro fertilization (IVF).

Shah and collaborators found ART pregnancies among kidney transplant recipients were associated with a higher risk of some complications. They included increased rates of hypertension 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 kidney transplant survival between ART and natural conceptions — an encouraging sign that ART is a viable and ultimately safe option.

“It’s safe for women with kidney transplants to pursue ART, provided they have stable creatinine value, optimal immunosuppression, well-controlled blood pressure and no recent episodes of rejection,” said Shah. “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 impacted.

"This research is an important step in understanding how best to support kidney transplant recipients who are considering pregnancy with assisted reproductive technology and enhances our ability as physicians to help patients make informed reproductive choices.”

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

The research team also included Anthony Leonard, PhD, biostatistician and adjunct associate professor in UC’s Department of Biostatistics, Health Informatics and Data Sciences; Prasoon Verma, MD, assistant professor of pediatrics and neonatologist at Cincinnati Children’s Hospital; and graduate student collaborators Brenna Rachwal, Pragati Basera and Nisha Sheshashayee.

Collaborators from other institutions included Prema Vyas, MD, Texas Christian University; Swati Rao, MD, 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 Transplant Pregnancy Registry International - Gift of Life Institute in Philadelphia.

END