Preconception counseling, fertility, and pregnancy complications after abdominal organ transplantation: a survey and cohort study of 532 recipients

Rupley, Devon M.; Janda, Allison M.; Kapeles, Steven R.; Wilson, Tim M.; Berman, Deborah R.; Mathur, Amit K.

doi:10.1111/ctr.12393

Cited by 35 publications

(36 citation statements)

References 16 publications

(21 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…If these women are not educated about this change in fertility, then unwanted or unplanned pregnancies may occur. Current evidence suggests that education regarding fertility, contraception, and pregnancy after LT is poor and this article highlights an important lesson on why it needs to improve . First, in this series, a TOP was associated with an adverse event in 25% of instances including severe hemorrhage, precipitation of ACR, and sepsis necessitating auxiliary graft removal.…”

Section: Discussionmentioning

confidence: 86%

“…In light of the recommendation from the NTPR and the data presented in this and other series, it appears clear that all women should now be counseled to delay pregnancy for at least a year after LT because of the increased risk of rejection associated with pregnancy before this time period has elapsed. Female LT recipients need to be counseled before and after LT regarding this and to be educated about contraception use …”

Section: Discussionmentioning

confidence: 99%

“…Graft loss directly related to ACR in pregnancy appears rare with the majority of episodes controlled with immunosuppression (IS) augmentation or intravenous steroids. Although ACR during pregnancy is unpredictable, there is evidence that delaying pregnancy for at least 12 months following LT is associated with a lower risk . Regarding non–graft‐related maternal complications the incidence of pre‐eclampsia and eclampsia are increased with rates of between 14% and 23% .…”

mentioning

confidence: 99%

See 2 more Smart Citations

Outcomes of pregnancy following liver transplantation: The King's College Hospital experience

et al. 2015

View full text Add to dashboard Cite

Reports of pregnancy in liver transplantation (LT) patients have largely favorable outcomes. Concerns remain with regards to maternal and graft risk, optimal immunosuppression (IS), and fetal outcomes. We review all post-LT pregnancies at our center with regard to the outcomes and safety for the patient, graft, and fetus. A total of 117 conceptions occurred in 79 patients. Median age at conception was 29 years. Maternal complications included graft loss (2%), acute cellular rejection (ACR; 15%), pre-eclampsia/eclampsia (15%), gestational diabetes (7%), and bacterial sepsis (5%). ACR was significantly more common in those women who conceived within 12 months of LT (P = 0.001). The live birth rate was 73%. Prematurity occurred in 26 (31%) neonates, and 24 (29%) neonates were of low or very low birth weight. IS choice (cyclosporine versus tacrolimus) had no significant effect on pregnancy outcomes and complications. No congenital abnormalities occurred, and only 1 child born at 24 weeks had delayed developmental milestones. In conclusion, pregnancy following LT has a favorable outcome in the majority, but severe maternal risks remain. Patients should be counseled with regard to the above information so informed decisions can be made, and pregnancy must be considered high risk with regular monitoring by transplant clinicians and specialist obstetricians.

show abstract

Section: Discussionmentioning

confidence: 86%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

See 1 more Smart Citation

Outcomes of pregnancy following liver transplantation: The King's College Hospital experience

et al. 2015

View full text Add to dashboard Cite

show abstract

“…Table 4. 17 In our study, we found significant deficiencies in the overall documentation of reproductive health counseling in post-transplant patients, many of the specifics of which should ideally be discussed during the pre-transplant evaluation process. 17 In our study, we found significant deficiencies in the overall documentation of reproductive health counseling in post-transplant patients, many of the specifics of which should ideally be discussed during the pre-transplant evaluation process.…”

Section: Factors Associated With Reproductive Counseling (Female Trmentioning

confidence: 83%

Deficiencies in reproductive health counseling in liver transplant recipients

Phillips

Saha

Foley

et al. 2019

Clinical Transplantation

View full text Add to dashboard Cite

Background In liver transplant (LT) recipients of childbearing age, there is often rapid return of fertility post‐transplant. Our aim was to determine whether healthcare providers are documenting reproductive health counseling in LT recipients. Methods We performed a review of 365 LT recipients (164 female, 201 male) of childbearing age transplanted between 1994 and 2015 at a single center. We evaluated documentation of reproductive health counseling, content of the counseling and its provider. Results Reproductive health counseling was documented in 7% of LT recipients (14% of females, 0.5% of males). The transplant team provided the counseling in 56%, obstetrics/gynecology in 35%, and primary care in 9%. Twenty‐four post‐LT pregnancies occurred; these were unplanned in 13%. Miscarriage/stillbirth occurred in 7/24 pregnancies (29%). Mycophenolic acid was used by 20% of female recipients at conception. Only age at transplant (P = 0.001) and post‐LT pregnancy was associated with documentation of reproductive health counseling in female recipients (P = 0.0001). Conclusion Despite rapid return of fertility in reproductive‐aged LT recipients, documentation of reproductive health counseling in this population is rare in men and women. This increases the potential for adverse maternal and fetal outcomes in this high‐risk population.

show abstract

“…21,22 A recent case report reported that transplanted organs from a male donor can lead to the presence of a Y chromosome in the maternal cfDNA pool with a genetically normal female fetus. [21][22][23] In instances such as these, it is important to counsel the patient with a history of organ transplant on this potential issue during pretest counseling, and to follow-up with a fetal morphology ultrasound scan in the second trimester, or amniocentesis for prenatal karyotype analysis to confirm the gender. Wherein gender discordance occurs with a fetus with XY chromosome and ultrasound shows female genitalia, it is important to reassess the fetus with repeat growth scans and evaluate for other causes of discordant results.…”

Section: History Of Maternal Organ Transplantmentioning

confidence: 99%

Modifying Risk of Aneuploidy with a Positive Cell-Free Fetal DNA Result

Long

Abuhamad

Warsof

2016

Clinics in Laboratory Medicine

View full text Add to dashboard Cite

Preconception counseling, fertility, and pregnancy complications after abdominal organ transplantation: a survey and cohort study of 532 recipients

Abstract: This study suggests that transplant patients are being counseled against pregnancy despite acceptable risks of complications and no specific effects on long-term graft function.

Cited by 35 publications

References 16 publications

Outcomes of pregnancy following liver transplantation: The King's College Hospital experience

Outcomes of pregnancy following liver transplantation: The King's College Hospital experience

Deficiencies in reproductive health counseling in liver transplant recipients

Modifying Risk of Aneuploidy with a Positive Cell-Free Fetal DNA Result

Contact Info

Product

Resources

About