Pregnancy outcome in liver transplant recipients

To evaluate pregnancy course, complications, and outcomes in liver transplant recipients.

We conducted a retrospective review of 38 pregnancies conceived between 1992 and 2002 in 29 women who underwent liver transplantation at Mount Sinai Medical Center.

The most common primary liver disease was autoimmune hepatitis. All patients were on immunosuppressive regimens that included cyclosporine A or tacrolimus. There were four spontaneous first-trimester abortions and ten first-trimester terminations for worsening liver function. The interval from transplantation to pregnancy was shorter in the group that had abortions and terminations (24.4 +/- 24.3 months) as compared with the group that had live births (47.8 +/- 28.7 months), P =.02. There were 24 live births to 20 patients. The mean gestational age at delivery was 36.4 weeks, and the mean birth weight was 2762 g. Pregnancy complications included preeclampsia (20.8%), chronic hypertension (20.8%), hemolysis, elevated liver enzymes, low platelets syndrome (8.3%), creatinine 1.3 mg/dL or more (25.0%), anemia (33.3%), diabetes (37.5%), cesarean delivery (45.8%), preterm birth less than 37 weeks (29.2%), intrauterine growth restriction (16.7%), and biopsy-proven graft rejection during pregnancy (16.7%). There were no intrauterine or neonatal deaths. All 5-minute Apgar scores were greater than 7. Four minor congenital anomalies were noted. Before 1997, there were five maternal deaths, 10-54 months after pregnancy. Pregnancy complications in our population were more common in those patients who delivered from 1992 to 1997 than in those who delivered from 1998 to 2002.

Pregnancy planned at least 2 years after liver transplantation with stable allograft function can have excellent maternal and neonatal outcome.