As there are about 14,000 women of reproductive age in the U.S. who have undergone liver transplantation (LT), data about the outcomes of pregnancy are important for counseling. A review and meta-analysis (Liver Transpl 2012; 18: 621-29) provides some information; going forward the National Transplantation Pregnancy Registry (NTPR) which was established in 1991 offers the promise of additional insight.
In the current review, Deshpande et al found 8 of 578 studies which met inclusion criteria; in total 450 pregnancies in 306 LT recipients were examined. While healthy live births were the most common outcome, there were several pertinent risks identified. The main concerns were development of preeclampsia, rejection/graft loss as well as the potential for birth defects. While miscarriage rates were similar to the general population (15.6% compared with 17.1%), the following were much higher:
- preeclampsia 21.9% vs. 3.8% in general population
- cesarean section delivery 44.6% vs. 31.9% in general population
- preterm birth 39.4% vs. 12.5% in general population
While rates of rejection and graft loss are not given for the entire cohort, specific study results were discussed. In one study, rates of acute rejection ranged from 2% to 8% and loss of graft within two years of pregnancy occurred in 6-11%.
Similar to rejection data, the data for birth defects was not uniformly reported. Specific study results were discussed and included several birth defects: 1 patient with total anomalous pulmonary venous return, 1 with pyloric stenosis, 2 with hypospadias, 1 with tracheoesophageal fistula, 1 with unilateral cystic kidney, and 2 with ventricular septal defects.
Liver transplant recipients can have successful pregnancies but should be considered high risk. Active reporting to established registries can give more accurate and up-to-date information.