Most Pregnancies After Living Kidney Donation Are Uncomplicated, but Hypertensive Risk Is Modestly Higher

11 Nov Most Pregnancies After Living Kidney Donation Are Uncomplicated, but Hypertensive Risk Is Modestly Higher

MedicalResearch.com Interview with:

Dr. Amit Garg, MD, PhD

Amit X. Garg, MD, PhD

Associate Dean, Clinical Research, Schulich School of Medicine & Dentistry
Department of Medicine, Division of Nephrology
Department of Epidemiology and Biostatistics
Past President, Canadian Society of Nephrology
Scientist, Lawson Health Research Institute
Lead, ICES Provincial Kidney, Dialysis and Transplantation Program (ICES KDT)
Schulich School of Medicine & Dentistry

MedicalResearch.com: What is the background for this study?

Response: Living kidney donation provides an important opportunity for someone with kidney failure to receive a transplant and live a longer, healthier life. Many living kidney donors may also consider pregnancy after donation, so it is important that they have reliable information about potential pregnancy-related risks when making an informed decision about donation.

Earlier studies suggested that gestational hypertension and preeclampsia may occur more often after kidney donation, but the number of postdonation pregnancies studied was relatively small and uncertainty remained about the magnitude of the risk. We therefore expanded our previous Ontario study across three Canadian provinces to provide more precise estimates and to examine a broader range of maternal, fetal, and neonatal outcomes.

MedicalResearch.com: What are the main findings?

Response: The most important finding is that most pregnancies after living kidney donation were uncomplicated.

However, hospitalization with a diagnosis of gestational hypertension, preeclampsia, or eclampsia occurred in 11.9% of donor pregnancies compared with 8.3% of matched nondonor pregnancies with similarly good baseline health, corresponding to a relative risk of about 1.5.

It was reassuring that these hypertensive disorders were generally first recorded close to term. Fewer than 2% of pregnancies in either group had the outcome first recorded before 34 weeks.

Most other maternal, fetal, and neonatal outcomes were similar between the groups. One secondary outcome that differed was small-for-gestational-age birth, which occurred in 13.8% of donor pregnancies compared with 7.9% of nondonor pregnancies. Because we examined multiple secondary outcomes, this finding requires confirmation in other studies.

MedicalResearch.com: What should readers take away from your report?

Response: I think the appropriate message is reassuring but balanced. A desire to become pregnant in the future should not, by itself, prevent someone from becoming a living kidney donor. Most postdonation pregnancies in our study were uncomplicated.

At the same time, donor candidates who may become pregnant should be informed that kidney donation may be associated with a modestly higher chance of gestational hypertension or preeclampsia. This information should form part of informed counselling before donation.

For donors who later become pregnant, appropriate prenatal care is important, with particular attention to blood pressure and other signs of hypertensive disorders of pregnancy.

MedicalResearch.com: What recommendations do you have for future research as a result of this work?

Response: There are several important next steps.

First, the finding of more small-for-gestational-age births should be confirmed in independent populations. There is biological plausibility that reduced kidney function could alter the normal kidney and vascular adaptations to pregnancy and affect placental development, but whether this explains our observation is not known.

Second, future studies should identify which donors may be at greatest risk. In our subgroup analyses, there was a suggestion that the relative increase in hypertensive disorders was greater among pregnancies occurring at age 35 years or older, but subgroup findings are less precise and require confirmation.

Third, prospective studies that include measured blood pressure, kidney function, albuminuria, body mass index, medication use, and other clinical information would help refine individual risk estimates.

Finally, additional study in more diverse populations is important. Race and ethnicity were unavailable in our data, and further research is particularly needed among donors of African ancestry, including those with APOL1 high-risk genotypes.

MedicalResearch.com: Is there anything else you would like to add? Any disclosures?

Response: Living kidney donation has enormous value for people with kidney failure. These findings should not be interpreted as suggesting that people who may become pregnant should not donate a kidney, or that healthy kidney donors should avoid pregnancy. Rather, they provide better information for shared decision-making before donation and for appropriate care during subsequent pregnancies.

An important principle is that when transplant programs enable living kidney donation, they also have a responsibility to ensure that donors who later become pregnant have access to appropriate pregnancy care.

I have no conflicts of interest to disclose. The funding and support for the study, as well as disclosures for all authors, are reported in the JAMA publication.

For a broader overview of donor health, see this MedicalResearch.com interview on the health risks to living kidney donors.

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Last Updated on November 11, 2026 by Marie Benz MD FAAD