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

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.