Poster Session 4
Ophelia Yin, MD
Maternal-Fetal Medicine Fellow
Division of Maternal Fetal Medicine and Reproductive Genetics, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco
San Francisco, CA, United States
Lisa Coscia, BS, RN
Transplant Pregnancy Registry International, Gift of Life Institute
Philadelphia, Pennsylvania, United States
Serban Constantinescu, MD, PhD
Section of Nephrology, Hypertension, and Kidney Transplantation, Department of Medicine, Lewis Katz School of Medicine, Temple University
Philadelphia, Pennsylvania, United States
Michael Moritz, MD
Transplant Pregnancy Registry International, Gift of Life Institute
Philadelphia, Pennsylvania, United States
Roxanna Irani, MD, PhD
Division of Maternal Fetal Medicine and Reproductive Genetics, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco
San Francisco, California, United States
We aim to characterize trends in aspirin use in the kidney transplant population and the associations of aspirin use with preeclampsia, obstetric outcomes, and graft function.
Study Design: We conducted a retrospective cohort study using the Transplant Pregnancy Registry International of pregnancies after kidney transplant reaching 20 weeks gestation with year of conception from 2000 onwards. The primary outcome was preeclampsia with delivery at < 37 weeks. Univariate and multivariable logistic regression was performed in R.
Results:
Our analysis included 708 pregnancies after kidney transplant resulting in 723 livebirths. Of the 708 pregnancies, 74 (10.5%) reported aspirin use and 634 (89.5%) reported no aspirin use in pregnancy. There was a significant increase in aspirin use over time, from 3.1% in 2000 to 25.0% in 2019, p< 0.001 (Figure 1). Aspirin use was associated with higher body mass index (BMI) (27 vs 25 kg/m2), later year of conception (2014 vs 2009), and living unrelated kidney donor (32.4% vs 15.7%), all p< 0.01. After adjustment for chronic hypertension, year, diabetes, pre-pregnancy creatinine, multiple gestation, donor type, and BMI, preeclampsia with delivery < 37 weeks occurred in 20 (27.0%) of aspirin use and 135 (21.3%) of no aspirin use pregnancies, (aOR 1.22, 95% CI 0.64 to 2.24, p=0.5). Aspirin use was associated with postpartum hemorrhage (6.8% vs 2.2%, p=0.04) but not blood transfusion (5.4% vs 1.7%, p=0.06) and aspirin use was associated with reduced rates of small for gestational age neonates (9.1% vs 19.8%, p=0.02). Aspirin use was not associated with any adverse graft outcomes including creatinine changes in pregnancy, acute graft rejection, or graft loss 2 years from time of delivery.
Conclusion:
In kidney transplant recipients who reported aspirin use in pregnancy, there was no difference in rates of preeclampsia with preterm delivery. The lack of association could be due to variation in dosage, timing of use, and indication. The increased rates of postpartum hemorrhage and reduction in rates of small for gestational age babies warrants future prospective investigation.
