Childbearing After Liver Transplantation

Abstract

Seventeen female patients who underwent orthotopic liver transplantation between June 1973 and June 1987 became pregnant 5 months to 11 years after transplantation. Immunosuppression was maintained with combinations of prednisone, cyclosporine, and azathioprine prior to and during pregnancy. One patient discontinued immunosuppression after knowledge of pregnancy, taking only azathioprine sporadically. Mean age at time of delivery was 26 years. Twelve patients had no alteration in liver function studies; 7 patients demonstrated mild or moderate enzyme elevations prior to delivery, with one case of rejection confirmed by percutaneous liver biopsy. Major problems related to pregnancy were hypertension, anemia, and hyperbilirubinemia. Twenty live births occurred (2 patients had 2 separate pregnancies, one patient had a set of twins); 13 were by cesarean section, 7 by vaginal delivery. Eleven of the 13 cesarean births were premature by gestational age. All vaginal births were term. Toxemia of pregnancy and early rupture of membranes were the principal indications for cesarean section. There were no congenital abnormalities or birth defects and all the children are surviving well. Fifteen of 16 children older than one year all have normal physical and mental development, with one child manifesting immature speech development. Four children are under one year, all with normal milestones thus far. Sixteen of the 17 mothers are alive from 2-18 years after transplantation; the only death was from a lymphoma, almost 4 years after transplantation and 2 1/2 years after delivery. This experience suggests that women undergoing liver transplantation can safely bear children despite an increased risk of premature cesarean births. The effect of chronic immunosuppression of female pediatric patients on their reproductive potential later in adulthood remains to be fully evaluated but the results so far are favorable.

Pregnancy after liver transplantation

“…2 In 17 female liver transplant recipients who became pregnant, major problems related to pregnancy were hypertension, anemia, and hyperbilirubinemia. There were no congenital abnormalities or birth defects in the newborns, and 15 of 16 children had normal development.…”

“…Sixteen of the 17 mothers were alive 2 to 18 years after OLT, with 1 maternal death from lymphoma. 2 As an addendum to the article, an 18th transplant recipient subsequently delivered 2 children. She underwent OLT for chronic active hepatitis.…”

Contracepção e gravidez após transplante hepático: uma visão atual

“…O resultado daquela gestação foi o nascimento de um menino saudável com 40,5 semanas de gravidez e pesando 2400 g. Na época do relato, 12 meses após o nascimento, mãe e criança estavam em excelente saúde (26) . A primeira grande série de gestações após TH foi publicada em 1990 pelo grupo da Universidade de Pittsburgh (23) . Em 17 receptoras de TH que engravidaram, os principais problemas ocorridos durante a gestação foram hipertensão arterial, anemia e hiperbilirrubinemia.…”

“…O TH, além de tratar a doença hepática de base, resgata vários aspectos que englobam o amplo conceito de qualidade de vida, incluindo a recuperação da atividade sexual e reprodutiva, frequentemente comprometidas nessa população. O retorno da fertilidade após TH bem sucedido é evidenciado pelo crescente número de gestações relatadas por diversos centros de transplantes (1,2,3,4,10,12,13,15,17,19,23,25,26,27) .…”

Contraception and pregnancy after liver transplantation

“…2,[4][5][6][7][8][9][10][11][12][13][14] The National Transplantation Pregnancy Registry follows up pregnancies reported to them from throughout the United States. 15,16 From these reports, we can draw several conclusions (Table 1).…”