Reproductive Counseling in Kidney Transplant: Patient Needs and Current Practices
1Internal Medicine, Brookdale University Hospital, Brooklyn, NY, 2Obstetrics and Gynecology, St Luke's University Health Network, Bethlehem, PA, 3Obstetrics and Gynecology, University of California San Francisco, San Francisco, CA, 4University of California San Francisco, San Francisco, CA, 5Pediatric GI/Hepatology, University of California San Francisco, San Francisco, CA, 6Nephrology, University of California San Francisco, San Francisco, CA, 7GI/Hepatology, University of California San Francisco, San Francisco, CA
Meeting: 2022 American Transplant Congress
Abstract number: 18
Keywords: Kidney transplantation, Pregnancy
Topic: Clinical Science » Kidney » 33 - Kidney Psychosocial
Session Information
Session Time: 3:30pm-5:00pm
Presentation Time: 4:10pm-4:20pm
Location: Hynes Ballroom A
*Purpose: Nearly 20% of female kidney transplant (KT) recipients are reproductive-aged. Early/unplanned pregnancies post-KT increase maternal and fetal risks, though data on reproductive counseling in this population are scarce.
*Methods: Female patients aged 14-45 years who were listed or had prior KT at our center (n=682) were invited to complete a 65-question online survey evaluating patient experiences and practices regarding reproductive counseling in KT.
*Results: 152 (22%) women completed the survey (50 pre- and 102 post-KT), with a median age of 36 (IQR 29-40); 32% were Hispanic, 27% White, 16% Asian, and 11% Black.
At the time of KT, 51 (50%) post-KT patients reported wishing to have children, though 26 (26%) were unaware that future pregnancy was possible. 22 (15%) were advised never to conceive, 19 (13%) that it would be dangerous, and 9 (6%) that pregnancy was not possible after KT. Overall, 92 (61%) of patients recalled receiving any pregnancy or preconception counseling pre-KT.
The majority (63%) of respondents were sexually active within the first year after transplant, and a quarter (24%) exclusively used less effective contraceptive methods, such as condoms or withdrawal. Over one third (39%) reported unprotected sex post-KT.
Among 28 pregnancies post-KT, 7 were unplanned and 20 resulted in live births. 5 women reported conceiving while taking teratogenic mycophenolic acid products of whom 1 had a miscarriage.
Most respondents felt family planning counseling was important to receive during both pre- (61%) and post- (72%) transplant time periods. About half (48%) of surveyed women felt their pre-KT reproductive counseling was adequate, while 63% reported satisfaction with the counseling they received after KT. Among those who received counseling, this was conducted by transplant providers in 51% of patients. Importantly, counseling from transplant providers was the single most favored modality reported by patients for receipt of reproductive information.
*Conclusions: Family planning was frequently discussed with KT recipients, although the information conveyed was not consistently accurate. During the first year after transplant, a quarter of sexually active women relied on contraception with higher failure rates. Given the risks of unplanned pregnancies, particularly in the early post KT period, enhanced reproductive counseling from transplant providers should be conducted throughout the pre- and post-transplant setting.
To cite this abstract in AMA style:
Rajagopal S, Ritchie J, Seidman D, Srisengfa Y, Perito ER, Adey D, Sarkar M. Reproductive Counseling in Kidney Transplant: Patient Needs and Current Practices [abstract]. Am J Transplant. 2022; 22 (suppl 3). https://atcmeetingabstracts.com/abstract/reproductive-counseling-in-kidney-transplant-patient-needs-and-current-practices/. Accessed November 21, 2024.« Back to 2022 American Transplant Congress