Pregnancy outcomes of liver transplant recipients: A systematic review and meta-analysis

Abstract

Approximately 14,000 women of reproductive age are currently living in the United States after liver transplantation (LT), and another 500 undergo LT each year. Although LT improves reproductive function in women with advanced liver disease, the associated pregnancy outcomes and maternal-fetal risks have not been quantified in a broad manner. To obtain more generalizable inferences, we performed a systematic review and meta-analysis of articles that were published between 2000 and 2011 and reported pregnancy-related outcomes for LT recipients. Eight of 578 unique studies met the inclusion criteria, and these studies represented 450 pregnancies in 306 LT recipients. The post-LT live birth rate [76.9%, 95% confidence interval (CI) ¼ 72.7%-80.7%] was higher than the live birth rate for the US general population (66.7%) but was similar to the post-kidney transplantation (KT) live birth rate (73.5%). The post-LT miscarriage rate (15.6%, 95% CI ¼ 12.3%-19.2%) was lower than the miscarriage rate for the general population (17.1%) but was similar to the post-KT miscarriage rate (14.0%). The rates of pre-eclampsia (21.9%, 95% CI ¼ 17.7%-26.4%), cesarean section delivery (44.6%, 95% CI ¼ 39.2%-50.1%), and preterm delivery (39.4%, 95% CI ¼ 33.1%-46.0%) were higher than the rates for the US general population (3.8%, 31.9%, and 12.5%, respectively) but lower than the post-KT rates (27.0%, 56.9%, and 45.6%, respectively). Both the mean gestational age and the mean birth weight were significantly greater (P < 0.001) for LT recipients versus KT recipients (36.5 versus 35.6 weeks and 2866 versus 2420 g). Although pregnancy after LT is feasible, the complication rates are relatively high and should be considered during patient counseling and clinical decision making. More case and center reports are necessary so that information on post-LT pregnancy outcomes and complications can be gathered to improve the clinical management of pregnant LT recipients. Continued reporting to active registries is highly encouraged at the center level.

Review on immunosuppression in liver transplantation

“…Post liver transplant pregnancies are classified as highrisk pregnancies due to the increased rate of complications that include hypertension, preeclampsia and preterm delivery [96] . Fewer complications may be expected when the pregnancy is planned.…”

“…Fewer complications may be expected when the pregnancy is planned. The time of conception is advised to be at least one year after transplantation, and some suggest waiting 2 years for a better outcome [96] . Overview and management of immunosuppression in liver transplanted female candidates for pregnancy need expertise to balance the risk of rejection and maternal and fetal complications.…”

Pregnancies in liver and kidney transplant recipients: a review of the current literature and recommendation

“…Actually, there are 100,000 female KTRs and 14,000 female LTRs living in the United States who are of reproductive age [3,4]. As restoration of fertility has become frequent after kidney or liver transplantation, this situation presents a chance for young women wishing to have a baby.…”

“…As a result, pre-eclampsia, preterm delivery and caesarean sections could be observed more frequently in KTRs than in LTRs (Figs. 2bed; the data of these figures rely on meta-analyses of different study cohorts [3,4]). …”

“…However, most of these studies rely on retrospectively assessed uni-centre experiences. Since the 1990s, three large multi-centric registries have been established: the National Transplantation Pregnancy Registry (NTPR) in the United States, a registry in the United Kingdom and another one in Australia/New Zealand [3,4]. In addition to including a review of these registries, here we report on the recently published single-centre reports on pregnancies in LTRs or KTRs.…”