Favorable pregnancy outcomes observed after liver transplant
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Severe transplant-related maternal complication and offspring prematurity may occur at a higher proportion after liver transplant vs. the general population, but overall outcomes are positive, researchers reported at UEG Week Virtual.
“Amenorrhea is reported in nearly 30% to 50% of women with cirrhosis, and this is an important problem; in fact, they represented one-third of all liver transplant recipients and approximately one-third of them are of reproductive age,” Salvatore Stefano Sciarrone, MD, of the multivisceral transplant unit at University of Padua, Italy, said during a presentation. “Successful liver transplant restores menstrual function in 97% of female patients as well as the childbearing potential. ... The optimal time for planning pregnancy after liver transplant includes immunosuppression at stable dosing without rejection episodes in the previous year, stable graft function and absence of infections.”
To investigate the outcomes of pregnancy after liver transplant (LT) at a national level, Sciarrone and colleagues analyzed 60 LT recipients (median age, 24 years at LT), comprising 62 pregnancies (median age, 31 years at pregnancy), from 14 Italian LT centers between 1990 and 2018. Studied endpoints included graft injury and function parameters during pregnancy as well as outcomes for both mother and newborn. Researchers noted the median time from LT to conception was 8 years.
According to study findings, four maternal complications of decompensated gestational diabetes, cholangitis, preeclampsia and urinary tract infection occurred during pregnancy with successful recovery. The live birth rate was 100% with prematurity and low birth weight occurring in 40.3% and 12.9% of newborns, respectively; low birth weight correlated with high values of aspartate aminotransferase (19.5 U/L, 21 U/L and 25 U/L), alanine aminotransferase (20 U/L, 20 U/L and 21.5 U/L) and gamma glutamyl transpeptidase (22 U/L, 14.5 U/L and 14 U/L) in the first, second and third trimester, respectively. Though cyclosporine and tacrolimus were used among 25 and 37 mothers, respectively, there was no correlation with maternal or newborn outcomes. Sciarrone added there were no observed incidences of congenital abnormality overall.
“Pregnancy in liver transplant recipients has good outcomes. However, maternal complication and prematurity may occur. We found an association between low birth weight and maternal graft dysfunction,” Sciarrone said. “There was acceptable mother and newborn survival in the long term, but we suggest a multidisciplinary management of pregnancy after liver transplantation so we can prevent the possibility of complications.”
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Stefano S, et al. Abstract OP094. Presented at: UEG Week; Oct. 3-5, 2021 (virtual meeting).
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