Hany M. EL HENNAWY, Omar SAFAR, Ghaleb ABOELSAMH, Laylah SADAGHA, Menna EL HENNAWY, Mohamed E. BALLA, Abdullah KHEDR, Mona IBRAHIM, Tariq JABER, Ibrahim TAWAHRI
Experimental and Clinical Transplantation - 2026;24(3):199-209
Objectives: Pregnancy after living kidney donation is associated with increased risk of preeclampsia and other hypertensive disorders; however, clinical practice and a standardized approach remain unclear. We performed a systematic review and meta-analysis to provide updated risk estimates for adverse pregnancy outcomes after living kidney donation, to allow development and preliminary assessment of the Simplified Pregnancy Risk Score, a structured framework for individualized risk stratification. Materia ls and Methods: We followed PRISMA guidelines and se-arched PubMed, Scopus, Web of Science, and the Cochrane Library through August 2023 to include studies on maternal and fetal outcomes in pregnancies after living kidney donation. We used random-eff ects models to pool odds ratios and calculate absolute risk differences. We used subgroup and regression analyses to identify key risk modifiers that informed the development of the points-based Simplified Pregnancy Risk Score. Results: Our search identified 15 studies encompassing 4200 pregnancies. Preeclampsia (pooled incidence 7.2%; odds ratio = 2.86; 95% CI, 1.62-5.05; absolute risk difference +4.7%) and gestational hypertension (odds ratio = 2.53, 95% CI, 1.11-5.74) were significantly increased in donors compared with nondonors. Risk of preterm birth was modestly increased (odds ratio = 1.32; 95% CI, 1.01-1.74). Subgroup analyses identified clinically relevant effect modifiers: donors aged >=35 years had higher odds of preeclampsia than younger donors, and a donation-to-conception interval of <2 years was associated with increased risk of preterm birth. The Simplified Pregnancy Risk Score integrated 8 evidence-based factors into a simple points-based system, categorizing donors as low (0-2 points), moderate (3-5 points), or high risk (>=6 points). Conclusions: The Simplified Pregnancy Risk Score represents the first structured, evidence-informed framework designed to support individualized preconception counseling and risk-aware antenatal management in kidney donors. Although formal validation is required, this system addresses a critical translational gap by converting population-level evidence into actionable clinical risk stratification.
