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

c437fd9d7ff9dcd1ff000e9dff0082597fd234ff00600ffc437fd9d7ff009dcd1fd93ff511ff0094bffba07b4f2fc7fe01f7bd15f047fc3a77fe0965ff0048d3fd803ff10dff00675ffe77347fc3a77fe0965ff48d3fd803ff0010dff675ff00e77347f64ffd447fe52ffee81ed3cbf1ff00807def457c11ff000e9dff0082597fd234ff00600ffc437fd9d7ff009dcd1ff0e9dff82597fd234ff600ff00c437fd9d7ff9dcd1fd93ff00511ff94bff00ba07b4f2fc7fe01f7bd15f047fc3a77fe0965ff48d3fd803ff0010dff675ff00e77347fc3a77fe0965ff0048d3fd803ff10dff00675ffe77347f64ff00d447fe52ff00ee81ed3cbf1ff807def457c11ff0e9dff82597fd234ff600ff00c437fd9d7ff9dcd1ff000e9dff0082597fd234ff00600ffc437fd9d7ff009dcd1fd93ff511ff0094bffba07b4f2fc7fe01f7bd15f047fc3a77fe0965ff0048d3fd803ff10dff00675ffe77347fc3a77fe0965ff48d3fd803ff0010dff675ff00e77347f64ffd447fe52ffee81ed3cbf1ff00807def457c11ff000e9dff0082597fd234

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}}}}}\pard\sb0\sl240{\bkmkstart Pg1}{\bkmkend Pg1}\par\pard\ql \li4782\sb0\sl207\slmult0 \par\pard\ql\li4782\sb1\sl207\slmult0 \up0 \expndtw0\charscalex147 \ul0\nosupersub\cf2\f3\fs14 The\ul0\nosupersub\cf3\f4\fs18 new england journal \ul0\nosupersub\cf2\f3\fs14 of\ul0\nosupersub\cf3\f4\fs18 medicine \par\pard\ql \li5718\sb0\sl276\slmult0 \par\pard\ql\li5718\sb0\sl276\slmult0 \par\pard\ql\li5718\sb4\sl276\slmult0 \up0 \expndtw0\charscalex140 \ul0\nosupersub\cf1\f2\fs24 original article \par\pard\ql \li3492\sb0\sl400\slmult0 \par\pard\ql\li3492\ri1066\sb122\sl400\slmult0\tx4909 \up0 \expndtw0\charscalex98 \ul0\nosupersub\cf6\f7\fs36 Gestational Hypertension and Preeclampsia \line\tab \up0 \expndtw0\charscalex96 in Living Kidney Donors \par\pard\ql \li3553\sb0\sl240\slmult0 \par\pard\ql\li3553\ri1195\sb13\sl240\slmult0\tx3949 \up0 \expndtw7\charscalex100 \ul0\nosupersub\cf7\f8\fs20 Amit X. Garg, M.D., Ph.D., Immaculate F. Nevis, Ph.D., Eric

McArthur, M.Sc., \line\tab \up0 \expndtw9\charscalex96 Jessica M. Sontrop, Ph.D., John J. Koval, Ph.D., Ngan N. Lam, M.D., \par\pard\ql \li3778\ri1420\sb0\sl240\slmult0\tx4023 \up0 \expndtw8\charscalex100 Ainslie M. Hildebrand, M.D., Peter P. Reese, M.D., Leroy Storsley, M.D., \line \up0 \expndtw8\charscalex97 John S. Gill, M.D., Dorry L. Segev, M.D., Ph.D., Steven Habbous, M.Sc., \line\tab \up0 \expndtw8\charscalex100 Ann Bugeja, M.D., Greg A. Knoll, M.D., Christine Dipchand, M.D., \up0 \expndtw8\charscalex100 Mauricio MonroyCuadros, M.D., and Krista L. Lentine, M.D., Ph.D., \par\pard\ql \li5662\sb9\sl230\slmult0 \up0 \expndtw5\charscalex100 for the DONOR Network* \par\pard\ql \li6207\sb0\sl241\slmult0 \par\pard\ql\li6207\sb140\sl241\slmult0 \up0 \expndtw5\charscalex100 \ul0\nosupersub\cf12\f13\fs21 ABSTRACT \par\pard\ql \li3380\sb0\sl207\slmult0 \par\pard\ql\li3380\sb0\sl207\slmult0 \par\pard\ql\li3380\sb34\sl207\slmult0 \up0 \expndtw2\charscalex100 \ul0\nosupersub\cf13\f14\fs18 Background\par\pard\sect\se

ctd\sbknone\cols2\colno1\colw3270\colsr110\colno2\colw7820\colsr160\qj \li619\ri0\sb100\sl180\slmult0\fi0 \up0 \expndtw2\charscalex100 \ul0\nosupersub\cf8\f9\fs15 The authors\u8217? affiliations are provided in \line \up0 \expndtw6\charscalex100 the Appendix. Address reprint requests to \line \up0 \expndtw6\charscalex95 Dr. Garg at the London Kidney Clinical \ul0\nosupersub\cf9\f10\fs15 Re\line \up0 \expndtw3\charscalex100 search\ul0\nosupersub\cf8\f9\fs15 Unit, Rm. ELL101, Westminster \line \up0 \expndtw4\charscalex100 Tower, London Health Sciences Centre, \line \up0 \expndtw4\charscalex100 800 Commissioners Rd. E., London, ON \line \up0 \expndtw4\charscalex100 N6A 4G5, Canada, or at amit.garg@lhsc\line \up0 \expndtw6\charscalex100 .on.ca.\par\pard\qj \li620\ri0\sb180\sl180\slmult0\tx699 \up0 \expndtw4\charscalex100 *A complete list of active investigators in \line\tab \up0 \expndtw4\charscalex100 the Donor Nephrectomy Outcomes Re\par\pard\qj \li700\ri0\sb0\sl180\slmult0 \up0 \expndtw2\charscalex100 searc

h (DONOR) Network is provided \up0 \expndtw2\charscalex100 in the SupplementaryAppendix, avail\line \up0 \expndtw6\charscalex100 able at NEJM.org.\par\pard\qj \li620\ri0\sb180\sl180\slmult0 \up0 \expndtw6\charscalex93 This article waspublished on November 14, \up0 \expndtw6\charscalex96 2014, at NEJM.org.\par\pard\qj \li620\ri798\sb180\sl180\slmult0 \up0 \expndtw6\charscalex90 \ul0\nosupersub\cf10\f11\fs14 N Engl J Med 2015;372:12433. \line \up0 \expndtw6\charscalex93 DOI: 10.1056/NEJMoa1408932\par\pard\ql \li620\sb35\sl138\slmult0 \up0 \expndtw5\charscalex94 \ul0\nosupersub\cf11\f12\fs12 Copyright 2014 Massachusetts Medical Society.\par\pard\ql \li620\sb0\sl218\slmult0 \par\pard\ql \li620\sb0\sl218\slmult0 \par\pard\ql \li620\sb0\sl218\slmult0 \par\pard\ql \li620\sb0\sl2

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18\slmult0 \par\pard\ql \li620\sb0\sl218\slmult0 \par\pard\ql \li620\sb0\sl218\slmult0 \par\pard\ql \li620\sb0\sl218\slmult0 \par\pard\ql \li620\sb0\sl218\slmult0 \par\pard\ql \li620\sb0\sl218\slmult0 \par\pard\ql \li620\sb0\sl218\slmult0 \par\pard\ql \li620\sb0\sl218\slmult0 \par\pard\ql \li620\sb0\sl218\slmult0 \par\pard\ql \li620\sb0\sl218\slmult0 \par\pard\ql \li620\sb0\sl218\slmult0\par\pard\ql \li620\sb0\sl218\slmult0 \par\pard\ql \li620\sb0\sl218\slmult0 \par\pard\ql \li620\sb0\sl218\slmult0 \par\pard\ql \li620\sb0\sl218\slmult0 \par\pard\ql \li620\sb153\sl218\slmult0 \up0 \expndtw2\charscalex100 \ul0\nosupersub\cf4\f5\fs19 124\par\pard\column \qj \li20\ri1040\sb42\sl240\slmult0 \up0 \expndtw1\charscalex100 \ul0\nosupersub\cf14\f15\fs20 Young women wishing to become living kidney donors frequently ask whether ne\line \up0 \expndtw0\charscalex100 phrectomy will affect their future pregnancies.\par\pard\ql \li3380\sb0\sl207\slmult0 \par\pard\ql \li20\sb41\sl207\slmult0 \up0 \expndtw0\charscalex100\ul0\nosupersub\cf13\f14\fs18 Methods\par\pard\qj \li20\ri1039\sb26\sl240\slmult0 \up0 \expndtw5\charscalex100 \ul0\nosupersub\cf14\f15\fs20 We conducted a retrospective cohort study of living kidney donors involving 85 women \line \up0 \expndtw4\charscalex100 (131 pregnancies after cohort entry) who were matched ina 1:6 ratio with 510 healthy \line \up0 \expndtw0\charscalex108 nondonors fromthe general population (788 pregnancies after cohort entry). \line \up0 \expndtw2\charscalex100 Kidney donations occurred between 1992 and 2009 in Ontario, Canada, with follow\line \up0 \expndtw0\charscalex100 up through linked health care databases until March 2013. Donors and nondonors \line \up0 \expndtw0\charscalex100 were matched with respect to age, year of cohort entry, residency (urban or rural), \line \up0 \expndtw0\charscalex100 income, number of pregnancies befor

e cohort entry, and the time to the first preg\line \up0 \expndtw0\charscalex102 nancy after cohort entry. The primary outcome was a hospital diagnosis of gesta\line \up0 \expndtw0\charscalex100 tional hypertension or preeclampsia. Secondary outcomes were each component of \line \up0 \expndtw0\charscalex100 the primary outcome examined separately and other maternal and fetal outcomes.\par\pard\ql \li3380\sb0\sl207\slmult0 \par\pard\ql \li20\sb41\sl207\slmult0 \up0 \expndtw4\charscalex100 \ul0\nosupersub\cf13\f14\fs18 Results\par\pard\qj \li20\ri1039\sb27\sl239\slmult0 \up0 \expndtw0\charscalex100 \ul0\nosupersub\cf14\f15\fs20Gestational hypertension or preeclampsia was more common among living kidney \line \up0 \expndtw0\charscalex100 donors than among nondonors (occurring in 15 of131 pregnancies [11%] vs. 38 of \line \up0 \expndtw3\charscalex100 788 pregnancies [5%]; odds ratio for donors, 2.4; 95% confidence interval, 1.2 to 5.0; \line\up0 \expndtw0\charscalex100 P\u8201?=\u8201?0.01). Each component of the prima

ry outcome was also more common among \line \up0 \expndtw0\charscalex106 donors(odds ratio, 2.5 for gestational hypertension and 2.4 for preeclampsia). \line \up0 \expndtw0\charscalex100 There were no significant differences between donorsand nondonors with respect \line \up0 \expndtw2\charscalex100 to rates of preterm birth (8% and 7%, respectively) or low birth weight (6% and 4%, \line \up0 \expndtw0\charscalex100 respectively). There were no reports of maternal death, stillbirth, or neonatal death \line \up0 \expndtw0\charscalex100 among the donors. Most women had uncomplicated pregnancies after donation.\par\pard\ql \li3380\sb0\sl207\slmult0 \par\pard\ql \li20\sb41\sl207\slmult0 \up0 \expndtw1\charscalex100 \ul0\nosupersub\cf13\f14\fs18 Conclusions\par\pard\qj \li20\ri1040\sb26\sl240\slmult0 \up0 \expndtw2\charscalex100 \ul0\nosupersub\cf14\f15\fs20 Gestational hypertension or preeclampsia was more likely to be diagnosed in kidney \up0 \expndtw0\charscalex108 donors than in matched nondonors with similar indicato

rs of baseline health. \up0 \expndtw0\charscalex100 (Funded by the Canadian Institutes of Health Research and others.)\par\pard\ql \li4489\sb0\sl172\slmult0 \par\pard\ql \li4489\sb0\sl172\slmult0 \par\pard\ql \li4489\sb0\sl172\slmult0 \par\pard\ql \li4489\sb0\sl172\slmult0 \par\pard\ql \li1129\sb78\sl172\slmult0\tx3830 \up0 \expndtw3\charscalex100 \ul0\nosupersub\cf5\f6\fs14 n engl j med 372;2\u8195?nejm.org\u8195?january\tab \up0 \expndtw6\charscalex92 8, 2015\par\pard\ql \li1043\sb133\sl184\slmult0 \up0 \expndtw2\charscalex100 \ul0\nosupersub\cf15\f16\fs16 The New England Journal of Medicine \par\pard\sect\sectd\sbknone \ql \li2241\ri2154\sb4\sl200\slmult0\tx3405 \up0 \expndtw2\charscalex100 Downloaded from nejm.org on August 14, 2015. For personal use only. No other uses with

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out permission. \line\tab \up0 \expndtw3\charscalex100 Copyright 2015 Massachusetts Medical Society. All rights reserved. \par\pard\sect\sectd\fs24\paperw11340\paperh15120{\shp{\*\shpinst\shpleft800\shptop9220\shpright5600\shpbottom10060\shpwr3\shpfblwtxt0\shpbxpage\shpbypage\shpz66\shplid1{\sp{\sn shapeType}{\sv 75}}{\sp{\sn fBehindDocument}{\sv 1}}{\sp{\sn pib}{\sv {\pict\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}}}}}

\pard\sb0\sl240{\bkmkstart Pg2}{\bkmkend Pg2}\par\pard\ql \li2992\sb0\sl195\slmult0 \par\pard\ql\li2992\sb3\sl195\slmult0 \up0 \expndtw0\charscalex132 \ul0\nosupersub\cf16\f17\fs17 Hypertension and Preeclampsia in Kidney Donors\par\pard\sect\sectd\sbknone\cols3\colno1\colw1699\colsr40\colno2\colw3532\colsr110\colno3\colw5829\colsr160\li1122\sb0\sl108\slmult0\ql \par\pard\li1122\sb0\sl108\slmult0\ql

{\shp {\*\shpinst\shpleft1022\shptop771\shpright1839\shpbottom1819\shpfhdr0\shpbxpage\shpbypage\shpwr3\shpwrk0\shpfblwtxt1\shpz10001\shplid10001{\sp{\sn shapeType}{\sv 202}}{\sp{\sn fFlipH}{\sv 0}}{\sp{\sn fFlipV}{\sv 0}}{\s

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p{\sn fRecolorFillAsPicture}{\sv 0}}{\sp{\sn fUseShapeAnchor}{\sv 0}}{\sp{\sn fLine}{\sv 0}}{\sp{\sn fFilled}{\sv 0}}{\sp{\sn fLayoutInCell}{\sv 1}}{\sp{\sn fBehindDocument}{\sv 0}}{\shptxt\pard\plain \qj\sl1092 \li0\ri0 \expndtw0\charscalex119\ul0\nosupersub\cf17\f18\fs94 E{\par}}}}\par\pard\column \qj \li1231\sb0\sl240\slmult0 \par\pard\qj \li20\ri0\sb168\sl240\slmult0 \up0 \expndtw0\charscalex119 \ul0\nosupersub\cf14\f15\fs20 ach year,more than 27,000 persons \line \up0 \expndtw0\charscalex102 worldwide become living kidney donors; \line \up0 \expndtw0\charscalex104 the majority are women.\ul0\super\cf18\f19\fs20 1\ul0\nosupersub\cf14\f15\fs20 Young female\par\pard\column \qj \li1231\sb0\sl240\slmult0 \par\pard\qj \li20\ri1810\sb169\sl240\slmult0 \up0 \expndtw2\charscalex100 participants, (reported as \u8804?5). The data were ana\line \up0 \expndtw0\charscalex105 lyzed by personnel at the Institute for Clinical \up0 \expndtw6\charscalex100 Evaluative Sciences. \par\pard\sect\sectd\sbknone \li1231\sb8\sl230\slmult0\fi0 \up0 \expndtw0\charscalex102 donors frequently ask whether kidney donation\par\pard\sect\sectd\sbknone\cols2\colno1\colw5261\colsr110\colno2\colw5829\colsr160\qj \li1231\ri0\sb2\sl240\slmult0\fi0\up0 \expndtw2\charscalex100 will affect future pregnancies.\ul0\super\cf18\f19\fs20 2\ul0\nosupersub\cf14\f15\fs20 In late pregnancy, \line \up0 \expndtw0\charscalex106 animals that have undergone uninephrectomy \line \up0 \expndtw0\charscalex100 have higher levels of blood pressure and urinary \line \up0 \expndtw0\charscalex101 protein excretion than control animals with two \line \up0 \expndtw0\charscalex102 kidneys.\ul0\super\cf18\f19\fs20 3,4\ul0\nosupersub\cf14\f15\fs20 In humans, the glomerular filtration \line \up0 \expndtw0\charscalex104 rateis reduced by about 35% early after donor \line \up0 \expndtw0\charscalex100 ne

phrectomy,\ul0\super\cf18\f19\fs20 5\ul0\nosupersub\cf14\f15\fs20 and women with a similar loss of \line \up0 \expndtw0\charscalex101 kidney function from various diseases are at in\line \up0 \expndtw2\charscalex100 creased risk for preeclampsia.\ul0\super\cf18\f19\fs20 6\ul0\nosupersub\cf14\f15\fs20 Studies of therisk \line \up0 \expndtw0\charscalex105 of nongestational hypertension among kidney \line \up0 \expndtw0\charscalex102 donors, as compared with nondonors, havehad \line \up0 \expndtw2\charscalex100 conflicting results, with some studiesshowing an \line \up0 \expndtw0\charscalex100 increased risk\ul0\super\cf18\f19\fs20 7,8\ul0\nosupersub\cf14\f15\fs20 and others showing no increase \line \up0\expndtw1\charscalex100 in risk.\ul0\super\cf18\f19\fs20 9,10\par\pard\qj \li1231\ri0\sb0\sl240\slmult0\fi239 \up0 \expndtw0\charscalex105 \ul0\nosupersub\cf14\f15\fs20 A prominent 2004 international conference \line \up0 \expndtw0\charscalex107 concluded that kidney donation poses no risk \line \up0 \expndtw0\chars

calex103 with respect to future pregnancies.\ul0\super\cf18\f19\fs20 11\ul0\nosupersub\cf14\f15\fs20 However, \line \up0 \expndtw3\charscalex100 two subsequent studies, one from Norway and the \line \up0 \expndtw4\charscalex100 other from the United States, showed an increased \line \up0 \expndtw0\charscalex101 riskof gestational hypertension and preeclamp\line \up0 \expndtw2\charscalex100 sia in pregnancies after kidney donation, as com\line \up0 \expndtw0\charscalex109 pared with pregnancies before donation.\ul0\super\cf18\f19\fs20 12,13 \line \up0 \expndtw2\charscalex100 \ul0\nosupersub\cf14\f15\fs20 Those findings have been debated,\ul0\super\cf18\f19\fs20 1417\ul0\nosupersub\cf14\f15\fs20 and many \line \up0 \expndtw0\charscalex102 transplantation programs have not incorporated \line \up0 \expndtw0\charscalex109 this information into their informedconsent \line \up0 \expndtw1\charscalex100 processes. We conducted this study to determine \line \up0 \expndtw0\charscalex100 whether donors have a higher risk of

gestational \line \up0 \expndtw1\charscalex100 hypertension or preeclampsia than do nondonors \line \up0 \expndtw3\charscalex100 with similar indicators of baseline health. We also \line \up0 \expndtw2\charscalex100 compared other maternal and fetal outcomes.\par\pard\ql \li1231\sb0\sl241\slmult0 \par\pard\ql \li2698\sb39\sl241\slmult0 \up0 \expndtw0\charscalex137 \ul0\nosupersub\cf12\f13\fs21 Methods\par\pard\ql \li1231\sb0\sl207\slmult0 \par\pard\ql \li1231\sb1\sl207\slmult0 \up0 \expndtw4\charscalex100 \ul0\nosupersub\cf19\f20\fs18 Study Design\par\pard\qj \li1231\ri0\sb26\sl240\slmult0 \up0 \expndtw2\charscalex100 \ul0\nosupersub\cf14\f15\fs20 We conducted a retrospective, matchedcohort \line\up0 \expndtw6\charscalex100 study using linked health care databases in Ontar

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io, \line \up0 \expndtw0\charscalex101 Canada, where citizens have universal access to \line \up0 \expndtw2\charscalex100 hospital care and physician services.The conduct \line \up0 \expndtw0\charscalex104 and reporting of the study followed guidelines \line \up0 \expndtw0\charscalex107 for observational studies (seeTable S1 in the \line \up0 \expndtw1\charscalex100 Supplementary Appendix, available with the full \line \up0 \expndtw2\charscalex100 text of this article atNEJM.org).\ul0\super\cf18\f19\fs20 18\ul0\nosupersub\cf14\f15\fs20 The study was \line \up0 \expndtw0\charscalex104 designed by the authors and approved by are\line \up0 \expndtw2\charscalex100 gional ethics committee. To comply with privacy \line \up0 \expndtw0\charscalex100 regulations for minimizing the chanceof identi\line \up0 \expndtw0\charscalex103 fication of a study participant, numbers of par\line \up0 \expndtw1\charscalex100 ticipants are suppressed in thecase of 5 or fewer\par\pard\column \ql \li20\sb10\sl207\slmult0 \up0 \expndtw4\charscalex100 \ul0\nosupersub\cf19\f20\fs18 Data Sources\par\pard\qj \li20\ri1809\sb26\sl240\slmult0\fi0 \up0 \expndtw0\charscalex100 \ul0\nosupersub\cf14\f15\fs20 We obtained information from four linked data\line \up0 \expndtw3\charscalex100 bases. The Trillium Gift of Life Network captures \line \up0 \expndtw2\charscalex100 information on all living kidney donors in Ontar\line \up0 \expndtw0\charscalex102 io. To ensure the accuracy and completeness of \line \up0 \expndtw2\charscalex100 the data, we manually reviewed the perioperative \line \up0 \expndtw1\charscalex100 medical charts of all persons who underwent do\line\up0 \expndtw0\charscalex105 nor nephrectomy at five major transplantation \line\up0 \expndtw0\charscalex101 centers in Ontario from 1992 through 2010. We \line \up0 \expndtw0\charscalex100 retrieved data regarding demographic character\l

ine \up0 \expndtw0\charscalex101 istics and vital status from Ontario\u8217?s Registered \line \up0 \expndtw0\charscalex103 Persons Database. We retrieved dataregarding \line \up0 \expndtw0\charscalex107 pregnancies and maternal and fetaloutcomes \line \up0 \expndtw1\charscalex100 from the Discharge Abstract Database of the Ca\line \up0 \expndtw0\charscalex103 nadian Institute for Health Information and the \line \up0 \expndtw0\charscalex103 Ontario Health Insurance Plandatabase. These \line \up0 \expndtw0\charscalex100 databases have been used extensively for epide\line \up0 \expndtw0\charscalex100 miologic and health services research, including \line \up0 \expndtw1\charscalex100 studies of living kidney donors and maternal and \line \up0 \expndtw0\charscalex103 fetal outcomes.\ul0\super\cf18\f19\fs20 1925\ul0\nosupersub\cf14\f15\fs20 Data were complete forall \line \up0 \expndtw0\charscalex103 variables in this study except the surgical tech\line \up0 \expndtw2\charscalex100 nique used for nephrectomy (open or

laparoscop\line \up0 \expndtw4\charscalex100 ic), which was missing for 14% of donors and was \line \up0 \expndtw2\charscalex100 reported only for patientswith complete data.\par\pard\ql \li5371\sb0\sl207\slmult0 \par\pard\ql \li20\sb31\sl207\slmult0 \up0 \expndtw0\charscalex103 \ul0\nosupersub\cf19\f20\fs18 Population\par\pard\ql \li20\sb54\sl218\slmult0 \up0 \expndtw8\charscalex92 \ul0\nosupersub\cf20\f21\fs19 Donors\par\pard\qj \li20\ri1809\sb4\sl240\slmult0 \up0\expndtw2\charscalex100 \ul0\nosupersub\cf14\f15\fs20 We included as donors all women who donated a \line \up0 \expndtw2\charscalex100 kidney between July 1,1992, and April 30, 2010, \line \up0 \expndtw0\charscalex103 in Ontario and whohad at least one pregnancy \line \up0 \expndtw0\charscalex101 with a gestationof at least 20 weeks during fol\line \up0 \expndtw3\charscalex100 lowup. (Theprimary outcome was assessed after\par\pard\qj \li20\ri1808\sb0\sl240\slmult0\up0 \expndtw7\charscalex100 20 weeks of gestation.) Each woman\u8217?s nephrec

tomy \line \up0 \expndtw0\charscalex104 date served as her cohortentry date. Toassess \line \up0 \expndtw2\charscalex100 new events during followup, we excluded wom\line \up0 \expndtw0\charscalex109 en in whom gestational hypertensionor pre\line \up0 \expndtw0\charscalex103 eclampsia had been diagnosed before donation \line \up0 \expndtw0\charscalex103 (in \u8804?5 women). We identified a matched set of \line \up0 \expndtw0\charscalex100 nondonors for 85 of 88 studyeligible donors, as \line \up0 \expndtw2\charscalex100 described below.\par\pard\ql \li5371\sb0\sl218\slmult0 \par\pard\ql \li20\sb41\sl218\slmult0 \up0 \expndtw8\charscalex93 \ul0\nosupersub\cf20\f21\fs19 Nondonors\par\pard\qj \li20\ri1809\sb4\sl240\slmult0\fi0 \up0 \expndtw0\charscalex100 \ul0\nosupersub\cf14\f15\

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fs20 Before nephrectomy, living donors undergo rig\line \up0 \expndtw0\charscalex102 orous health screening. We selected a similarly \line \up0 \expndtw1\charscalex100 healthy segment of the general population, using \line \up0 \expndtw4\charscalex100 restriction and matching.\ul0\super\cf18\f19\fs20 26\ul0\nosupersub\cf14\f15\fs20 We randomly assigned \line \up0 \expndtw2\charscalex100 a cohortentry date (simulated nephrectomy date) \par\pard\sect\sectd\sbknone \li3729\sb0\sl161\slmult0\par\pard\li3729\sb0\sl161\slmult0\par\pard\li3729\sb0\sl161\slmult0\par\pard\li3729\sb0\sl161\slmult0\par\pard\li3729\sb106\sl161\slmult0\fi0\tx6425\tx10433 \dn2 \expndtw3\charscalex100 \ul0\nosupersub\cf5\f6\fs14 nengl j med 372;2\u8195?nejm.org\u8195?january\tab \dn2 \expndtw6\charscalex928, 2015\tab \up0 \expndtw2\charscalex100 \ul0\nosupersub\cf4\f5\fs19 125\par\pard\ql \li4403\sb135\sl184\slmult0 \up0 \expndtw2\charscalex100 \ul0\nosupersub\cf15\f16\fs16 The New England Journal of Medicine \par\pard\ql \li2241\ri2154\sb3\sl200\slmult0\tx3405 \up0 \expndtw1\charscalex100 Downloaded from nejm.orgon August 14, 2015. For personal use only. No other uses without permission. \line\tab \up0 \expndtw2\charscalex100 Copyright 2015 Massachusetts Medical Society. All rights reserved. \par\pard\sect\sectd\fs24\paperw11340\paperh15120\pard\sb0\sl240{\bkmkstart Pg3}{\bkmkend Pg3}\par\pard\ql \li4092\sb0\sl207\slmult0 \par\pard\ql\li4092\sb1\sl207\slmult0 \up0 \expndtw0\charscalex149 \ul0\nosupersub\cf2\f3\fs14 The\ul0\nosupersub\cf3\f4\fs18 new england journal \ul0\nosupersub\cf2\f3\fs14 of\ul0\nosupersub\cf3\f4\fs18 medicine\par\pard\sect\sectd\sbknone\cols2\colno1\colw6029\colsr110\colno2\colw5061\colsr160\qj \li620\sb0\sl240\slmult0 \par\pard\qj \li2000\ri0\sb147\sl240\slmult0 \up0 \expndtw0\charscalex103 \ul0\nosupersub\cf14\f15\fs20 to all women who were citizens in Ontario, ac\

line \up0 \expndtw0\charscalex101 cording to the distribution of cohortentry dates \line \up0 \expndtw0\charscalex100 among donors (July 1, 1992, to April 30,2010). \line \up0 \expndtw1\charscalex100 We included women with an age that was within \line \up0 \expndtw0\charscalex103 the minimum and maximum ages of donors on \line \up0 \expndtw0\charscalex101 their cohort entry date and who had evidence of \line \up0 \expndtw0\charscalex107 at least one pregnancy carried to 20weeks of \line \up0 \expndtw2\charscalex100 gestation in followup (731,823 women).\par\pard\qj \li2000\ri0\sb0\sl240\slmult0\fi239 \up0 \expndtw1\charscalex100 We identified baseline illnesses and measures \line \up0 \expndtw4\charscalex100 of health care access from July 1, 1991 (the begin\line \up0 \expndtw3\charscalex100 ning of available database records), to the cohort\line \up0 \expndtw2\charscalex100 entry date. This provided a median of 11 years of \line \up0 \expndtw0\charscalex103 baseline assessment; 99% of the women had at \line \up

0 \expndtw0\charscalex101 least 2 years of available data. We restricted the \line \up0 \expndtw0\charscalex100 sample of eligible nondonors to women without \line \up0 \expndtw0\charscalex102 a known medical condition before cohort entry \line \up0 \expndtw0\charscalex103 that could preclude donation, including a diag\line \up0 \expndtw0\charscalex101 nosis of gestational hypertension or preeclamp\line \up0 \expndtw0\charscalex100 sia. (All restrictions are listed in TableS2 in the \line \up0 \expndtw0\charscalex102 Supplementary Appendix.) To ensurethat non\line \up0 \expndtw0\charscalex106 donors had the same opportunity asdonors to \line \up0 \expndtw0\charscalex102 obtain health care services from physicians, we \line \up0 \expndtw0\charscalex106 restricted the sample of eligible nondonors to \line \up0 \expndtw1\charscalex100 women who had visited a physician at least once \line \up0 \expndtw0\charscalex105 during the previous 2 years. (Results were not \line \up0 \expndtw0\charscalex105 materially different whe

n we removed this re\line \up0 \expndtw0\charscalex100 striction in a sensitivity analysis.) These restric\line \up0 \expndtw0\charscalex104 tions left 380,995 women (52% of the original \line \up0 \expndtw0\charscalex100 sample) as eligible nondonors.\par\pard\qj \li2000\ri0\sb0\sl240\slmult0\fi239 \up0 \expndtw0\charscalex105 We then matched six eligible nondonors to \line \up0 \expndtw3\charscalex100 each donor on the basis of baseline characteristics \line \up0 \expndtw0\charscalex103 that might be associated with the risk of gesta\line \up0 \expndtw0\charscalex100 tional hypertension or preeclampsia,\ul0\super\cf18\f19\fs20 27,28\ul0\nosupersub\cf14\f15\fs20 includ\line \up0 \expndtw0\charscalex109ing the age at the time of cohort entry, since \line \up0 \expndtw0\charscalex10

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4 extremes in age increase risk; the cohortentry \line \up0 \expndtw0\charscalex100 date (2 years), to account for era effects; urban \line \up0 \expndtw7\charscalex100 or rural residence (population, \u8805?10,000 or

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ccount for the correlation struc\line \up0 \expndtw0\charscalex109 ture withinmatched sets and in women with \line \up0 \expndtw3\charscalex100 more than onefollowup pregnancy. We repeated \line \up0 \expndtw1\charscalex100 the analysis of the primary outcome in three pre\line \up0 \expndtw0\charscalex101 specified subgroups, which were defined on the \line \up0 \expndtw0\charscalex103 basis of the presence or absence of at least one \line \up0 \expndtw3\charscalex100pregnancy before cohort entry, since the risk may \line \up0 \expndtw0\charscalex109 be higher in a first pregnancy; the time from \line \up0 \expndtw1\charscalex100 cohort entry to pregnancy (\u8804?2 or >2 years), since \line \up0 \expndtw0\charscalex104 the risk may be higher in the first 2 years after \line \up0\expndtw0\charscalex101 nephrectomy); and the median age during preg\line \up0\expndtw4\charscalex100 nancy (\u8804?32 years or >32 years), since the risk may \line \up0 \expndtw0\charscalex107 be higher among older women. To determine \line \up0 \expndtw5\charscalex100 whether subgroupspecific odds ratios differed, we \line \up0 \expndtw2\charscalex100 included an interaction term in each model; these \line \up0 \expndtw0\charscalex101 analyses were considered exploratory, since the \line \up0 \expndtw3\charscalex100 anticipated number of eventswas small. All anal\line \up0 \expndtw5\charscalex100 yses were performed withthe use of SAS software, \line \up0 \expndtw3\charscalex100 version 9.3 (SAS Institute). Continuous data were \line \up0 \expndtw1\charscalex100 summarized as medians and interquartile ranges. \par\pard\sect\sectd\sbknone \li620\sb203\sl218\slmult0\fi0\tx4489\tx7185 \up0 \expndtw2\charscalex100 \ul0\nosupersub\cf4\f5\fs19 126\tab \dn2 \expndtw3\charscalex100 \ul0\nosupersub\cf5\f6\fs14 n engl j med 372;2\u8195?nejm.org\u8195?january\tab \dn2 \expndtw6\charscalex92 8, 2

015\par\pard\ql \li4403\sb146\sl184\slmult0 \up0 \expndtw2\charscalex100 \ul0\nosupersub\cf15\f16\fs16 The New England Journal of Medicine \par\pard\ql \li2241\ri2154\sb3\sl200\slmult0\tx3405 \up0 \expndtw1\charscalex100 Downloaded fromnejm.org on August 14, 2015. For personal use only. No other uses without permission. \line\tab \up0 \expndtw2\charscalex100 Copyright 2015 Massachusetts Medical Society. All rights reserved. \par\pard\sect\sectd\fs24\paperw11340\paperh15120{\shp{\*\shpinst\shpleft5300\shptop11500\shpright10780\shpbottom11640\shpwr3\shpfblwtxt0\shpbxpage\shpbypage\shpz382\shplid3{\sp{\sn shapeType}{\sv 75}}{\sp{\sn fBehindDocument}{\sv 1}}{\sp{\sn pib}{\sv {\pict\jpegblipffd8ffe000104a46494600010101006000600000ffdb004300010101010101010101010101010101

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7/17/2019 Ssa

20/131

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7/17/2019 Ssa

21/131

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