Pregnancy outcomes in liver transplant recipients: A 15‐year single‐center experience

Kanzaki, Yu; Kondoh, Eiji; Kawasaki, K.; Mogami, Haruta; Chigusa, Yoshitsugu; Konishi, Ikuo

doi:10.1111/jog.13096

Cited by 25 publications

(23 citation statements)

References 16 publications

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“…The number of pregnancies in LT recipients has been rising steadily over the last few decades. Pregnancy outcomes in a meta‐analysis and a number of case series, including our own unit, are favorable, but inherent fetal and maternal risks remain . These women will expect and require extensive counseling regarding contraception and pregnancy from their transplant physicians and obstetrics team.…”

Section: Discussionmentioning

confidence: 99%

“…For young women, there is an expectation of returning to a normal quality of life after LT, including the ability to have children . Pregnancy outcomes following LT including previous reports from our own center have been shown to be favorable, but with an increased risk of premature birth, intrauterine growth restriction, and graft dysfunction . The dominant prepregnancy advice was to recommend deferral of pregnancy to a time period >1 year following transplant.…”

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confidence: 99%

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Successful pregnancy outcomes following liver transplantation is predicted by renal function

et al. 2018

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Liver transplantation (LT) is a successful treatment for both acute liver failure and end-stage liver disease. The number of women of reproductive age undergoing LT is increasing. Pregnancy outcomes are favorable, but there is still a lack of prognostic markers. We aimed to identify factors predictive of adverse pregnancy outcomes in LT recipients. An analysis of all pregnancies occurring in LT recipients from 1989 to 2016 at King's College Hospital was performed. Clinical data of 162 conceptions in 93 women were reviewed. Descriptive and regression analyses were done to examine associations between laboratory markers and hepatological scores with pregnancy outcomes of live birth and preterm birth. Median age at LT was 23 years (range, 1-41 years), with a median age at conception of 30 years (range, 18-47 years). The live birth rate was 75% (n = 121). Of live births, 35% (n = 39/110 available) were delivered preterm. Preconception creatinine levels were higher in patients who had a preterm birth (85 versus 74 μmol/L; P = 0.008), with a preconception estimated glomerular filtration rate (eGFR) <90 mL/minute significantly associated with preterm delivery (P = 0.04). Progressive decline in eGFR predicted outcome, with gestational length declining with increasing chronic kidney disease (CKD) stage: CKD 0-1 = 39 weeks (median), CKD 2 = 37 weeks, and CKD 3 = 35 weeks. The risk of preterm birth was greatest in women with an eGFR <60 mL/minute (P = 0.004). Moreover, hypertension-related complications during pregnancy, such as gestational hypertension, preeclampsia, or eclampsia, were also associated with prematurity (P = 0.01). Women taking steroid-based immunosuppression had an increased risk of infection during pregnancy or postpartum (15% versus 4%; P = 0.02). In conclusion, although the majority of women have a successful pregnancy outcome after LT, preconception renal function predicts pregnancy outcome and steroids increase risk of infection during pregnancy or postpartum. Liver Transplantation 24 606-615 2018 AASLD.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Successful pregnancy outcomes following liver transplantation is predicted by renal function

et al. 2018

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“…Rates of pre‐eclampsia in the general US population have previously been reported as 4% . Older studies in pregnant LT recipients have reported pre‐eclampsia rates of 21%‐26%, whereas newer studies have reported rates of 7%‐12% . Rates may have improved over time as a result of better management of immunosuppression and risk factors (Table ) associated with pre‐eclampsia.…”

Section: Maternal Outcomesmentioning

confidence: 99%

“…Rates of graft rejection in pregnant LT recipients can be highly variable between 0% and 20% . Unfortunately, some of these studies did not employ uniform diagnostic criteria for ACR.…”

Section: Maternal Outcomesmentioning

confidence: 99%

Pregnancy in Liver Transplantation

et al. 2020

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Pregnancy after liver transplantation (LT) is increasingly common and is a frequent scenario that transplant physicians, obstetricians, and midwives encounter. This review summarizes the key issues surrounding preconception, pregnancy‐related outcomes, immunosuppression, and breastfeeding in female LT recipients. Prepregnancy counseling in these patients should include recommendations to delay conception for at least 1‐2 years after LT and discussions about effective methods of contraception. Female LT recipients are generally recommended to continue immunosuppression during pregnancy to prevent allograft rejection; however, individual regimens may need to be altered. Although pregnancy outcomes are overall favorable, there is an increased risk of maternal and fetal complications. Pregnancy in this cohort remains high risk and should be managed vigilantly in a multidisciplinary setting. We aim to review the available evidence from national registries, population‐based studies, and case series and to provide recommendations for attending clinicians.

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“…However, it only takes a quick literature search to heighten concern. Case reports describe rejection and graft failure, pre‐eclampsia, fetal demise, maternal demise, and fetal anomalies . Unfortunately, the information available during prepregnancy counseling allows little predictive ability.…”

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confidence: 99%

Pregnancy after liver transplantation: Can renal function quell the fear?

Reau

2018

Liver Transpl

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Pregnancy outcomes in liver transplant recipients: A 15‐year single‐center experience

Abstract: Pregnancy after liver transplantation can achieve relatively favorable outcomes. Obstetricians should be involved in the contraceptive and fertility counseling of female transplant recipients to prevent unintended pregnancies.

Cited by 25 publications

References 16 publications

Successful pregnancy outcomes following liver transplantation is predicted by renal function

Successful pregnancy outcomes following liver transplantation is predicted by renal function

Pregnancy in Liver Transplantation

Pregnancy after liver transplantation: Can renal function quell the fear?

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