Pregnancies after liver transplant are high-risk but can be successful

Last Updated: 2015-09-22

By Laura Newman

NEW YORK (Reuters Health) - Pregnancies after liver transplant are successful in many cases but still must be considered high risk, according to researchers who reviewed outcomes at one large center.

Ongoing collaboration between the transplant team and maternal-fetal medicine is crucial, said Dr. Hyagriv Simhan, chief of maternal-fetal medicine at Magee Women's Hospital in Pittsburgh, who was not involved in the study. "Pregnancy ought to be undertaken after the transplant team and maternal-fetal medicine agree that disease status, medication regimen, and anti-rejection stability is optimized," Dr. Simhan told Reuters Health by email.

At King's College Hospital in London, Dr. Rachel H. Westbrook and colleagues reviewed data on 79 liver recipients who had 117 pregnancies between 1988 and 2011, at a median age of 29 and a median of 48 months posttransplant (range, 1 to 240 months).

There were 83 live births (72%), 20 miscarriages (17%), and 12 terminated pregnancies (10%), four of which were due to severe maternal complications, the researchers report in the September issue of Liver Transplantation.

Fifty-nine live-born infants (71%) had normal birth weight. Twenty-six (31%) were born at less than 37 weeks gestation. Thirty-four (41%) were delivered by cesarean.

None of the women died because of their pregnancy, but four required ICU care for complications. Two women (3%) lost their grafts, including one patient with a hepatic artery thrombosis in association with a spontaneous miscarriage.

"No common features existed in these women before conception that would have identified the four women at increased risk of requiring admission" to the ICU, the authors wrote.

In most cases, primary maintenance immunosuppression was based on cyclosporine (34 conceptions) or tacrolimus (81 conceptions). There was no difference in maternal or newborn outcomes based on the immunosuppression regimen.

The most common complications were pregnancy-induced hypertension (19%), pre-eclampsia/eclampsia (14%), acute cellular rejection (15%), gestational diabetes (7%), bacterial sepsis (5%), and viral infections (4%).

Notably, conceiving within a year of transplant was linked to a higher rate of acute cellular rejection (P=0.001).

During a median follow up of 52 months after delivery, there were three maternal deaths, none of them pregnancy-related, according to the researchers.

In addition, another eight women lost their grafts at a median of 60 months posttransplant. In all of these cases, "graft loss was thought to be unrelated to pregnancy," the authors said, but women with an episode of ACR during pregnancy were more likely to undergo retransplant (5/17 versus 3/99; P=0.001).

Dr. Renuka Bhattacharya, Medical Director of the Liver Transplant Program at University of Washington in Seattle, told Reuters Health that her center advises women to wait two years after transplantation before planning a pregnancy.

The new study, she said, "reinforces a lot of what we are doing and points out areas where we could improve."

Hepatologist Carla Coffin of the University of Calgary in Alberta, Canada, told Reuters Health by phone that her center too manages these pregnancies in a multidisciplinary fashion.

"This study really underscores the need for pre-pregnancy, contraception, and planned pregnancies," she said.

The authors did not respond to requests for comment.

SOURCE: http://bit.ly/1Mkad1R

Liver Transpl 2015.