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.

中文翻译：

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活体肾脏捐献后的妊娠、现有证据的系统回顾以及当前指南的回顾

了解和交流活体肾脏捐赠后妊娠并发症的风险是必要的，因为大多数活体肾脏捐赠者 (LKD) 都是育龄妇女。我们旨在确定所有检查捐献后妊娠并发症的原创研究文章，并比较相关指南的质量和一致性。我们搜索了截至 2020 年 12 月 18 日发布的 Embase、MEDLINE、PubMed、社会网页和指南登记处的英文出版物。筛选了 93 篇文章，从中确定了 16 项研究，共有 1399 例捐献后妊娠。感兴趣的结果，即捐赠后妊娠并发症，是无法计算的，只能对证据进行叙述性综合。先兆子痫的绝对风险从捐赠前的约 1%–3%（低于一般人群）增加到捐赠后的约 4%–10%（与一般人群相当）。胎儿和新生儿不良结局的风险在捐赠后和捐赠前妊娠之间没有差异。指南和共识声明在说明需要告知 LKDs 其捐赠后怀孕风险方面是一致的，但是，该指南的深度和范围是可变的。虽然捐赠后妊娠并发症的绝对风险仍然很低，但需要共同努力以更好地识别这些妇女的风险并使其个体化，以便真正知情同意捐赠。胎儿和新生儿不良结局的风险在捐赠后和捐赠前妊娠之间没有差异。指南和共识声明在说明需要告知 LKDs 其捐赠后怀孕风险方面是一致的，但是，该指南的深度和范围是可变的。虽然捐赠后妊娠并发症的绝对风险仍然很低，但需要共同努力以更好地识别这些妇女的风险并使其个体化，以便真正知情同意捐赠。胎儿和新生儿不良结局的风险在捐赠后和捐赠前妊娠之间没有差异。指南和共识声明在说明需要告知 LKDs 其捐赠后怀孕风险方面是一致的，但是，该指南的深度和范围是可变的。虽然捐赠后妊娠并发症的绝对风险仍然很低，但需要共同努力以更好地识别这些妇女的风险并使其个体化，以便真正知情同意捐赠。