Post-liver transplantation pregnancy outcomes and complications: A 17-year observational study from Iran

Although liver transplantation has afforded patients with cirrhosis a chance at both survival and motherhood, recipients are at higher risk of pregnancy complications and graft rejection. We aimed to describe our experiences with post-liver transplantation pregnancies over 17 years in Iran.

This retrospective observational study included female liver transplant recipients from 2002 to 2019 who became pregnant after their transplantation. Patient characteristics and both maternal and neonatal outcomes and complications, including gestational diabetes mellitus (GDM), pre-eclampsia, premature preterm rupture of membrane (PPROM), live birth, gestational age, birth weight, and mode of delivery were gathered. Graft rejection was evaluated through histopathologic assessment of core needle biopsy.

A total of 59 pregnancies were recorded from 39 patients (age at transplantation: 24.79 ± 5.61 years, age at conception: 29.67 ± 5.82 years), all of which were singleton pregnancies. The most common indication for transplantation was autoimmune hepatitis. Of the 59 pregnancies, 30 (76.9%) resulted in live births, and 36 patients (92.3%) achieved live births overall. PPROM, GDM, and pre-eclampsia occurred in 13%, 7%, and 3% of pregnancies, respectively, while graft rejection was observed in 8% of pregnancies. Six (13%) infants classified as very low birth weight, 18 (39%) as low birth weight, and two (4%) as overweight.

Our findings underscore the feasibility of pregnancy following liver transplantation. However, they also emphasize the critical importance of ongoing surveillance and coordinated multidisciplinary collaboration to ensure optimal care for this unique patient population.