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Renal function predicts preterm birth in liver transplant recipients

Preconception renal function predicted preterm birth in pregnant women who underwent prior liver transplantation, according to a recently published study.

“Our results show that the number of live births is increasing in parallel to the number of women of reproductive age undergoing LT. Moreover, the live birth rate has also increased significantly over the last three decades,” Tiong Y. Lim, MD, from King's College Hospital, London, and colleagues wrote. “There are currently limited prognostic markers predicting outcomes in LT recipients wishing to get pregnant. We have shown ... that preconception renal function is a useful marker to prognosticate pregnancy outcomes in women following LT.”

To identify new prognostic markers for maternal and fetal outcomes after liver transplantation, Lim and colleagues conducted a retrospective analysis of all pregnancies in LT recipients presented between 1989 and 2017 at their institution.

The study comprised 162 conceptions in 93 women. Median age at transplantation was 24 years (range, 1-41 years) and median age at conception was 30 years (range, 18-47 years).

While a small percentage experienced acute cellular rejection, infection, hypertension or graft decompensation during pregnancy, the researchers reported no pregnancy-related maternal death.

Of the 162 conceptions, 121 resulted in live birth, 10 were elective terminations of pregnancy, 29 resulted in miscarriage, and two were stillbirths. Median gestation was 36 weeks (range, 4-42 weeks).

Higher preconception MELD score correlated with prematurity (8 vs. 7; P = .01) and mycophenolate mofetil exposure correlated with a higher rate for miscarriage (50% vs. 16%; P = .04).

Median preconception estimated glomerular filtration rate (eGFR) was lower in patients who had a preterm birth (83 vs. 70 mL/min; P = .02). Preconception eGFR less than 90 mL/min (P = .04) and less than 60 mL/min (P = .004) correlated significantly with preterm delivery.

Additionally, median gestation time decreased with each increment in chronic kidney disease stage (P = .003), as 79% of pregnancies in patients with CKD stage 0 or 1 and 69% in patients with CKD stage 2 reached term compared with 33% in patients with CKD stage 3.

Multivariate analysis showed that preconception eGFR (OR = 0.98; 95% CI, 0.96-0.99) and gestational hypertension-related complications (OR = 4.34; 95% CI, 1.25-15.23) predicted preterm birth.

“Our results will help to tailor pregnancy counselling and care for women post LT,” the researchers wrote. “Due to the complexity of such pregnancies, it is recommended that all pregnancies in women post-LT are managed by a multidisciplinary team including transplant clinicians and specialist obstetricians.” – by Talitha Bennett

Disclosure: The authors report no relevant financial disclosures.