Pregnancy after liver transplantation

Abstract

The first known posttransplantation pregnancy was in 1958 in a renal transplant recipient who had received a kidney from her identical twin sister. The first known posttransplantation pregnancy in a liver transplant recipient was in 1978. Information available from female kidney transplant recipients helped in the decision making involved in the management of this case, as well as those that followed. Over the last 20 years, issues specific to liver transplantation and pregnancy have been identified. Similar to the kidney transplant recipient population, when prepregnancy recipient graft function is stable and adequate, pregnancy appears to be well tolerated. Also similar to kidney transplant recipients, there has been no evidence of a specific malformation pattern among the children, and although prematurity and low birth weight occur, overall newborn outcomes have been favorable. Pregnancy in the setting of recurrent liver disease, such as recurrent hepatitis C, poses a potential problem among liver transplant recipients, as well as the possible adverse effects of immunosuppression on maternal kidney function. Also of significance, peripartum graft deterioration has more severe consequences in this transplant recipient population. Therefore, pregnancy must be considered carefully in this transplant recipient group. Since 1991, the National Transplantation Pregnancy Registry (NTPR) has studied the safety of pregnancy outcomes in solid-organ transplant recipients. The purpose of this review is to catalog studies in the literature, as well as to present current data from the registry with management guidelines. (Liver Transpl 2000;6:671-685.)

In utero Exposure to Immunosuppressive Drugs

“…Immunosuppressive treatment is usually maintained at pre-pregnancy levels, with adjustments according to standard parameters such as cyclosporine A (CsA) trough levels or 2 h post-dose monitoring (C 2 ) [31]. It is still unclear whether there is a higher incidence of childhood cancers or sterility in the offspring of immunosuppressed mothers.…”

Pregnancy outcome after liver transplantation: A single-center experience of 71 pregnancies in 45 recipients

“…Recently, pregnancy outcomes with tacrolimus‐based immunosuppression have noted lower incidences of hypertension and preeclampsia when compared to CyA‐based therapy 10–13. The largest reported series to date is the United States National Transplantation Pregnancy Registry established in 1991 to monitor pregnancy outcomes in transplant recipients 14, 15. This registry has reported on 137 pregnancies from 41 centers and describes a live birth rate of over 70%, in addition to favorable fetal and maternal outcomes for the majority of recipients 14.…”

“…The largest reported series to date is the United States National Transplantation Pregnancy Registry established in 1991 to monitor pregnancy outcomes in transplant recipients 14, 15. This registry has reported on 137 pregnancies from 41 centers and describes a live birth rate of over 70%, in addition to favorable fetal and maternal outcomes for the majority of recipients 14. Data from this registry have shown that CyA, in comparison to tacrolimus, was associated with a higher incidence of preeclampsia and hypertension.…”

Liver Transplantation during Pregnancy for Acute Liver Failure due to HBV Infection: A Case Report

“…Described side effects during pregnancy after liver transplantation, when transplantation was performed before the begin of a pregnancy, are hypertension (26–46%), preeclampsia (9–26%), cholestasis (3–27%), graft rejection (7–12%), diabetes (5–13%), osteoporosis, neurotoxicity, impaired maternal renal function, maternal infections (9–27%), cesarean delivery (23–47%), preterm delivery (31–39%), fetal growth restriction (17–34%), indistinct fetal malformations (0–3%), and complications of the newborn (17–33%) with a perinatal mortality of 0–4% [19–24]. …”