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Pregnancy Outcomes in 53 Female Lung Transplant Recipients
Frank G Lee1, Lisa A Coscia2, Serban Constantinescu3
1Department of Surgery, Mayo Clinic, Rochester, MN.
Background:
Limited data exist to inform and appropriately counsel female lung transplant (LuT) recipients regarding pregnancy after transplantation.
Study Question:
What are the modifiable factors that impact pregnancy outcomes in female LuT recipients?
Study Design And Methods:
Retrospective observational analysis was performed on female LuT recipients who reported pregnancies after transplantation to the Transplant Pregnancy Registry International (TPRI).
Results:
Fifty-three recipients who underwent LuT from 1991 through 2021 reported 72 pregnancies to TPRI. Predominant indications for transplant were cystic fibrosis (60%) and pulmonary hypertension (19%). Contraceptive use after transplantation was 36%. Most recipients (54%) reported unplanned pregnancies. The live birth rate was 62%, resulting in 46 live births. Approximately 60% of births were premature (< 37 weeks' gestational age [GA]) and of low birth weight (LBW) (< 2,500 g). Birth defects were seen in 7 children (16%), none with mycophenolic acid (MPA) embryopathy. Three neonatal deaths resulted from extreme prematurity; 43 remaining children are healthy. Twenty recipients (38%) have died a median of 23.6 years after LuT. Recipients with transplant-to-conception interval of ≤ 2 years had no difference in mortality compared with those with transplant-to-conception interval of > 2 years (hazard ratio [HR], 1.26; 95% CI, 0.50-3.12; P = .625). Recipients whose first pregnancy after transplantation was unplanned showed lower survival (HR, 7.02; 95% CI, 1.35-36.45; P = .020). Newborns of LuT recipients with planned vs unplanned pregnancies had higher median GA (36.9 weeks vs 34 weeks; P = .025) and birth weight (2,639 g vs 2,155 g; P = .047), and significantly lower risk of LBW for singletons (OR, 0.26; 95% CI, 0.07-0.94; P = .036).
Interpretation:
Successful pregnancy after LuT is achievable, however, not without risks for mother and offspring. Our results showed that planned pregnancies resulted in higher GA and birth weight live births and showed lower mortality after pregnancy. TPRI data show 54% of recipients reported unplanned pregnancies, an obvious area for improvement. Planning pregnancy is the most modifiable factor for mitigating risks.
