Pregnancy after living kidney donation, a systematic review of the available evidence, and a review of the current guidance

Am J Transplant. 2022 Oct;22(10):2360-2380. doi: 10.1111/ajt.17122. Epub 2022 Aug 3.


Understanding and communicating the risk of pregnancy complications post-living kidney donation is imperative as the majority of living kidney donors (LKD) are women of childbearing age. We aimed to identify all original research articles examining complications in post-donation pregnancies and compared the quality and consistency of related guidelines. We searched Embase, MEDLINE, PubMed, society webpages, and guideline registries for English-language publications published up until December 18, 2020. Ninety-three articles were screened from which 16 studies were identified, with a total of 1399 post-donation pregnancies. The outcome of interest, post-donation pregnancy complications, was not calculable, and only a narrative synthesis of the evidence was possible. The absolute risk of pre-eclampsia increased from ~1%-3% pre-donation (lower than the general population) to ~4%-10% post-donation (comparable to the general population). The risks of adverse fetal and neonatal outcomes were no different between post-donation and pre-donation pregnancies. Guidelines and consensus statements were consistent in stating the need to inform LKDs of their post-donation pregnancy risk, however, the depth and scope of this guidance were variable. While the absolute risk of pregnancy complications remains low post-donation, a concerted effort is required to better identify and individualize risk in these women, such that consent to donation is truly informed.

Keywords: donor nephrectomy; donor outcomes; kidney transplantation; living donor; pre-eclampsia.

Publication types

  • Systematic Review

MeSH terms

  • Female
  • Humans
  • Infant, Newborn
  • Kidney
  • Kidney Transplantation* / adverse effects
  • Living Donors
  • Male
  • Nephrectomy / adverse effects
  • Pregnancy
  • Pregnancy Complications* / epidemiology
  • Pregnancy Complications* / etiology
  • Tissue and Organ Harvesting