Liver transplant linked to worse pregnancy-related complications
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SAN ANTONIO — Pregnant women who were liver transplant recipients had more pregnancy-related complications and worse hospital outcomes during admission, according to data presented at the American College of Gastroenterology Meeting.
“As more women of childbearing age undergo transplantation and subsequently experience pregnancy, issues regarding complications and the effect on outcomes will only become more relevant,” Lindsay A. Sobotka, DO, a second-year fellow at The Ohio State University Wexner Medical Center, told Healio Gastroenterology and Liver Disease. “It is crucial to recognize factors that worsen patient and hospital outcomes in order to reduce patient morbidity and health care costs.”
Sobotka and colleagues analyzed a large, nationwide inpatient sample of data from 2005 to 2013 of pregnant women for the study.
Pregnant women who received a liver transplant were more likely than those who did not to have any pregnancy-related complications (56.1% vs. 27.1; P < .001), have a miscarriage (3.2% vs. 0.8%; P < .001), intrauterine growth restriction (5.6% vs. 2%; P < .001), postpartum hemorrhage (5.8% vs. 2.7%; P < .001), hypertension during pregnancy (35.1% vs. 9.5%; P < .001), preeclampsia (17.8% vs. 4.1%; P < .001), or venous thromboembolism (3.9% vs. 0.4%; P < .001).
Additionally, the liver transplant recipients were more likely to require a cesarean delivery than those who did not undergo transplantation (OR = 2.27; 9% CI, 1.62-3.18).
Weighted analysis confirmed that pregnant women who received a transplant were more likely to experience a pregnancy-related complication (OR = 2.11; 95% CI, 1.63-2.76), have a longer length of hospital stay (1.52 day; 95% CI, 0.62-2.41), and higher costs of admission ($3,023; 95% CI, 850-5,197).
However, the data did not show an increased risk for mortality during pregnancy for women who received a transplant.
“These results continue to highlight that liver transplant patients can experience pregnancy without a significant risk for mortality,” Sobotka said. “While there has previously been concerns about transplant patients experiencing pregnancy given fear of complications and outcomes, we continue to provide evidence that pregnancy should not be advised against in this patient population.” – by Talitha Bennett
Reference:
Sobotka LA, et al. Abstract 13. Presented at: American College of Gastroenterology Annual Meeting; Oct. 25-30, 2019; San Antonio.
Disclosures: Sobotka reports no relevant financial disclosures.
Perspective
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Carlos Romero-Marrero, MD
The findings of this study are very helpful in the counseling of post liver transplant patients planning to conceive. Liver transplant patients are at higher risk for miscarriage, intrauterine growth restriction, hypertension and preeclampsia. This study put into numbers and percentages these known complications, which helps in the discussion with our childbearing-aged post-transplant patients.
A significant finding is that there was an increase in pregnancy-related complications – more than double compared with normal patients, while the survival was not affected. The results of this study emphasize the importance of the multidisciplinary care in patients who become pregnant after LT. These patients should be treated as high-risk pregnancies and a good communication between the obstetrician, the hepatologist and the perinatologist is helpful in maximizing outcomes.
We do not know from the abstract the timing of pregnancy after liver transplant, the liver allograft function at time of conception/pregnancy, immunosuppression status and information regarding comorbidities, such as diabetes and hypertension; all of which could affect pregnancy outcomes. It’s fair to say that, knowing most patients who are post-transplant are followed very carefully by their transplant centers, it’s likely the vast majority of patients had stable allograft function, immunosuppression and well managed comorbidities before becoming pregnant.
Ultimately, post liver transplant patients planning to conceive should discuss with their transplant providers about the right timing of conception. We usually recommend patients to wait at least 1 year after LT for conception. We also recommend having a good liver allograft function, being on a stable immunosuppression regime and having well controlled comorbidities. Once pregnant, post-LT patients should be followed closely by a multidisciplinary team.
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