Are Kidney and Liver Transplant an Obstacle to Becoming a Mother?

Pregnancy posttransplant remains high risk because of potential maternal, fetal, and graft-related complications. We retrospectively evaluated the clinical course, maternal-fetal outcomes, and graft-related events of pregnancies occurring after liver and kidney transplant at our center.

We evaluated 3538 kidney transplants and 760 liver transplants performed at Başkent University between November 3, 1975, and November 3, 2024. Female recipients who became pregnant posttransplant were identified through hospital electronic medical records, the transplant database, and obstetric archives. We performed a subgroup analysis on pediatric transplant recipients who underwent transplant at age <18 years and later became pregnant in adulthood.

Among 41 transplant recipients who experienced pregnancy, 20 were liver transplant and 21 were kidney transplant recipients. Each patient had 1 pregnancy. Mean maternal age at delivery was 31 years (range, 24-38 years), and mean interval between transplant and delivery was 9.9 years (range, 2-22 years). Liver transplant recipients received calcineurin inhibitor-based immunosuppression, whereas kidney transplant recipients received calcineurin inhibitors with prednisone, with azathioprine added in selected patients with history of frequent rejection. One patient delivered vaginally; all others underwent cesarean delivery. Maternal complications included hypertension in 1 patient, gestational diabetes in 3 patients, and lower urinary tract infection in 3 patients. One liver transplant recipient with autoimmune hepatitis developed recurrent disease in the early postpartum period and required retransplant. No other significant maternal complications or graft rejection episodes were observed. Mean gestational age was 35.5 weeks (range, 24-39 weeks). All infants were born healthy except 1, who died at 24 weeks of gestation due to placenta previa.

Pregnancy after liver and kidney transplant can be successfully sustained in most patients under appropriate immunosuppressive management and multidisciplinary follow-up. However, these pregnancies should be considered high risk and managed in experienced centers with close obstetric and transplant surveillance.