Dr Erandi Hewawasam1,2,3, Dr Christopher Davies1,2,3, Dr Brooke Huuskes3,4, Prof Elizabeth Sullivan5, Prof Stephen McDonald1,2,3,6, Prof Shilpanjali Jesudason1,2,3,6, Dr Nishanta Tangirala1
1Australia and New Zealand Dialysis and Transplant Registry (ANZDATA), South Australian Health and Medical Research Institute (SAHMRI), Adelaide, Australia, 2Faculty of Health and Medical Research Institute, University of Adelaide, Adelaide, Australia, 3Pregnancy and Kidney Research Australia, Adelaide, Australia, 4Department of Microbiology, Anatomy, Physiology and Pharmacology, School of Agriculture, Biomedicine and Environment, La Trobe University, , Australia, 5Faculty of Health and Medicine, University of New Castle, , Australia, 6Central Northern Adelaide Renal and Transplantation Services (CNARTS), Royal Adelaide Hospital, Adelaide, Australia
Biography:
Dr Hewawasam is a postdoctoral research fellow at the ANZDATA registry at SA Health and Medical Research Institute (SAHMRI). As the research coordinator of Pregnancy and Kidney Research Australia, she brings her expertise in coordinating data-linkage, registry studies, and consumer engagement to improve parenthood outcomes for Australians with kidney disease.
Abstract:
Aims: To investigate the short and long-term disease burden in children of transplanted mothers (C-Tx) versus those of mothers who had not received kidney replacement therapy (C-non-KRT, dialysis or transplantation).
Background: Despite increasing birth rates among kidney transplant recipients, their babies face heightened risks, including prematurity (<37 weeks’ gestation) and low birthweight (<2500g), with undefined long-term health implications.
Methods: We used linked Australia and New Zealand Dialysis and Transplant Registry (1970-2016), perinatal (births ≥20 weeks gestation, 1991-2013) and hospital admission datasets (until 2018) in SA, WA, ACT and NSW.
Results: Among 1,865,425 babies (6,063,327 hospital admissions), C-Tx had 137 birth and 551 subsequent admissions (99 babies).
Transplanted mothers, compared to non-KRT, were older (34 vs 30 years, p<0.001), and had 2-23 times higher rates of diabetes, chronic hypertension, pregnancy-induced hypertension (including pre-eclampsia), and caesarean sections, p<0.001. Their babies had 3-7 times higher rates of preterm birth, low birthweight, Apgar scores <7 and intensive care unit admissions p<0.001.
C-Tx had a median follow-up of 2.5 years [IQR: 0.9-5.3] (vs 2.9 years [1.1-5.4] C-non-KRT, p=0.03). Admissions per child were similar across groups: 40% had one admission, 20% had two, 15% had three, 5% had four, and 20% had five or more (p=0.07).
C-Tx had longer birth admissions (median 6 days, IQR: 4-16) than the C-non-KRT (3 days, 2-5, p<0.001), and a higher prevalence of conditions originating in the perinatal period during both birth admission (70% vs 34% C-non-KRT) and subsequent admissions (22% vs 8% C-non-KRT), p<0.001. These included disorders related to length of gestation/fetal growth, respiratory/cardiovascular, haemorrhagic/haematological, endocrine/metabolic, infections, and maternal factors/complications of pregnancy, labour and delivery, and were ~3-5 times more prevalent in C-Tx (p<0.05).
Conclusions: This Australian first study reveals significant perinatal morbidity from birth and beyond in C-Tx. Future prospective studies are essential to understand its impact and trajectory.
Keywords
Kidney transplantation, follow-up, neonatal