Pregnancy Outcomes Following Liver Transplantation

INTRODUCTION: This study reports pregnancy outcomes in women following liver transplantation to aid counselling and management of these women. METHODS: We conducted a retrospective study including women with pregnancies following liver transplantation followed at Mount Sinai Hospital, Toronto, Canada and University Hospital Leuven, Belgium between 1989 -2016. Pregnancy outcomes were reported as proportions. RESULTS: We identified 28 women that had 41 pregnancies following liver transplantation. The mean maternal age was 30 (±7) years and transplant-to-pregnancy interval was 8.5 (±5.1) years. Six women had received two liver transplants prior to conception, but had normal liver functions at the start of pregnancy. Immunosuppressants included tacrolimus ± azathioprine (26), cyclosporine (4) and prednisone with immunosuppressants (11). Maternal complications included hypertension (10), renal insufficiency (6), gestational diabetes (4), graft deterioration (2), infection (2) and anemia requiring blood transfusion (1). Fetal/neonatal adverse outcomes included two miscarriages, three stillbirths, one neonatal death, five small-for-gestational-age infants and one minor congenital anomaly. There were 22 term and 14 preterm infants with a mean gestational age of 36+5±4.23 weeks. Although the cesarean delivery rate was high (61%), all were performed for obstetric indications. CONCLUSION: With appropriate multidisciplinary care and with stable graft function at the onset of pregnancy, women with liver transplants can have successful pregnancies with low rates of graft complications, if they adhere to their immunosuppressive regimens. Graft deterioration responds well to increase in the dose of immunosuppressants and high-dose glucocorticoids. The use of these in pregnancy is not associated with adverse fetal/neonatal outcomes.