Pregnancies and Gynecological Follow-Up after Solid Organ Transplantation: Experience of a Decade

Abstract

In recent years, solid organ transplantations, such as kidney or lung grafts, have been performed worldwide with an improvement of quality of life under immunosuppressive therapy and an increase in life expectancy, allowing young women to consider childbearing. In the current study, we conduct a retrospective study in two French centers for kidney and lung transplantations to evaluate the rate and outcomes of pregnancies, contraception and gynecological monitoring for women under 40 years old who underwent solid organ transplantation. Among 210 women, progestin was the most widely used contraceptive method. Of the 210 women, 24 (11.4%) conceived 33 pregnancies of which 25 (75.8%) were planned with an immunosuppressant therapy switch. Of the 33 pregnancies, 7 miscarried (21.2%) and 21 (63.7%) resulted in a live birth with a high rate of pre-eclampsia (50%). No graft rejections were observed during pregnancies. Among the deliveries, 19 were premature (90.5%, mostly due to induced delivery) and the C-section rate was high (52.4%). No particular pathology was identified among newborns. We conclude that pregnancies following solid organ transplantation are feasible, and while they are at an increased risk of pre-eclampsia and prematurity, they should still be permitted with close surveillance by a multidisciplinary care team.

A single center Israeli experience in pregnancy post lung transplantation: Feasibility of successful two or more full‐term pregnancies in individual lung transplant recipients

“…This case series describes our single‐center experience with pregnancy after lung transplantation in Israel. Newborn outcomes in our cohort are significantly improved as compared to results reported in previously published case series 2–4,6 . Notably, we report the first series of two or more successful pregnancies in individual LTRs.…”

“…Newborn outcomes in our cohort are significantly improved as compared to results reported in previously published case series. [2][3][4]6 Notably, we report the first series of two or more successful pregnancies in individual LTRs. While female LTRs of reproductive age are increasingly considering pregnancy, it is generally limited to a single birth, with the decision on a second child generally deferred or considered only in the context of surrogacy.…”

“…1 While various centers have summarized their local experience in post-lung transplant pregnancy outcomes, the available data on pregnancies in women after lung transplantation remains limited to less than 80 patients published in various case series. [2][3][4][5][6] Given such limited experience, lung transplant programs have been reluctant to advocate for pregnancy following transplantation. Furthermore, lack of data have hindered the promulgation of consensus guidelines, and only recently has the International Society of Heart and Lung Transplantation (ISHLT) published a consensus expert statement on reproductive health issues in thoracic transplantation.…”

“…Improved survival rates and advances in patient care post‐lung transplantation have led to an increased interest in pregnancy among female lung transplant recipients (LTRs) of reproductive age 1 . While various centers have summarized their local experience in post‐lung transplant pregnancy outcomes, the available data on pregnancies in women after lung transplantation remains limited to less than 80 patients published in various case series 2–6 . Given such limited experience, lung transplant programs have been reluctant to advocate for pregnancy following transplantation.…”