Counseling Kidney Donors on Future Pregnancy, With Amit Garg, MD, PhD

Future pregnancy plans need not rule out living kidney donation, but candidates should be counseled on hypertensive risk.

New data on pregnancy after living kidney donation give transplant teams clearer numbers to share with donor candidates who may want children in the future.¹

In a matched cohort study from 3 Canadian provinces, presented at American Society of Nephrology (ASN) Kidney Week 2026 by Amit X. Garg, MD, PhD, and published simultaneously in JAMA, most donor pregnancies were uncomplicated, with a modest increase in hypertensive disorders of pregnancy.¹

Will Donating a Kidney Affect Future Pregnancies?

In 2024, more than 40,000 living kidney donations were reported across 88 countries.¹ For donors who may become pregnant later, Garg said the central question is whether donation will affect those pregnancies.

In the cohort of 385 donor pregnancies and 1,540 pregnancies in matched nondonors of similar baseline health, hospitalization with gestational hypertension, preeclampsia, or eclampsia occurred in 11.9% vs 8.3% (risk ratio [RR], 1.51; 95% CI, 1.10-2.08), and more than 88% of donor pregnancies were unaffected.¹ Small for gestational age births were also more common (13.8% vs 7.9%; RR, 1.86; 95% CI, 1.37-2.52), a secondary finding Garg said could reflect chance or biology. Rates of severe maternal morbidity, cesarean delivery, postpartum hemorrhage, gestational diabetes, preterm birth or low birth weight, and neonatal intensive care admission were similar between groups.¹

What Do the Findings Mean for Living Kidney Donation?

“If someone is interested in having a pregnancy after donation, that doesn’t preclude them from being a donor,” said Garg, professor of medicine, epidemiology and biostatistics at Western University, nephrologist at London Health Sciences Centre, and corresponding author of the study, in an interview with HCPLive.

Garg also emphasized encouraging healthy lifestyle behaviors after donation, noting obesity is associated with greater preeclampsia risk, along with appropriate monitoring for these complications. With living kidney donation performed worldwide, he said transplant centers should be confident donors will have access to good maternal care should they become pregnant.

How Should Clinicians Counsel Kidney Donor Candidates About Pregnancy?

The 2017 Kidney Disease: Improving Global Outcomes (KDIGO) guideline on living kidney donors recommends counseling donor candidates about the potential for an increased risk of gestational hypertension or preeclampsia.² According to Garg, the findings support this guidance, including asking candidates about future pregnancy plans during evaluation.

Age may matter in these conversations. In subgroup analyses, the RR for the primary outcome was larger among pregnancies at a maternal age of 35 years or older (14.3% vs 7.6%; RR, 1.99; 95% CI, 1.18-3.33) than among younger mothers (RR, 1.41; 95% CI, 0.93-2.15).¹

“When we counsel donor candidates, we should discuss the possible effect of donation on future pregnancy, including a higher risk of gestational hypertension or preeclampsia,” Garg said.

Investigators noted that most Canadian donors are White and receive care in publicly funded health systems, which may limit generalizability, and called for additional study among donors of African ancestry, including those with apolipoprotein L1 high-risk genotypes.¹

Editor’s Note: Garg reported no relevant disclosures.

References

1. Wang C, Naylor KL, McArthur E, et al. Pregnancy outcomes after living kidney donation. JAMA. Published online October 22, 2026. doi:10.1001/jama.2026.21737

2. Lentine KL, Kasiske BL, Levey AS, et al. KDIGO clinical practice guideline on the evaluation and care of living kidney donors. Transplantation. 2017;101(8S suppl 1):S1-S109. doi:10.1097/TP.0000000000001769