Contraception use differs across solid organ transplant types among women transplanted in reproductive age

The number of reproductive-age solid organ transplantation (SOT) recipients is growing, yet comparative data on contraception use across organ types are limited. We performed a retrospective cohort study of women who underwent first-time liver, kidney, heart, or lung transplantation between the ages of 18 and 45 years from 2015 and 2025 using TriNetX (n = 10 155). Contraception uptake within 2 years was assessed by organ, including patterns of initial contraceptive method and subsequent method changes, and clinical outcomes, including osteoporosis, thromboembolism, and graft rejection, were compared by contraception type. Among 10,155 eligible SOT recipients, 19.9% had documented contraception within 2 years of SOT (heart 27.3%, lung 22.5%, kidney 19.7%, liver 16.8%, P < .001). Combined oral contraception was the most common initial contraception method, followed by depot medroxyprogesterone acetate (DMPA). However, those who started on DMPA were more likely to switch methods. Compared with no contraception, DMPA was associated with increased risk of osteoporosis, hypertension, thrombosis, and graft rejection, whereas estradiol-containing agents were not. Overall, contraception use after SOT was uncommon with very low rates of highly effective options, particularly after liver and kidney transplant. Higher switching and adverse associations with DMPA support early, organ-tailored contraceptive counseling and careful method selection post-SOT.