Deficiencies in Reproductive Health Counseling in Liver Transplant Patients [2H]

Abstract

INTRODUCTION: Over 30% of female liver transplant patients are reproductive age. Fertility is quickly restored following transplant and unplanned pregnancy is common. Data on reproductive counseling in transplant patients are lacking. METHODS: Women ages 14-45 years who were listed, or with previous liver transplant (n=147) at an academic medical center were invited to complete an online survey in 2018. Questions explored contraception/pregnancy counseling, patient counseling preferences, and contraception use after transplant. RESULTS: Fifty (34%) women completed the survey, including 11 pre- and 39 post-transplant patients. Median age was 33 years; 76% were white, 20% Hispanic. Most (79%) reported reproductive counseling as “very important” to their post-transplant care, although 71% reported insufficient counseling received. Among pre-transplant women (n=11), 4 reported never discussing future pregnancy, 2 were advised never to conceive, and 3 were informed that pregnancy after transplant was impossible. During pre-transplant years only 14/38 (36%) received any counseling, of whom only 56% described counseling received as sufficient. While counseling after transplant was more common (74%), only 47% (18/38) of women reported contraception use in the first year post-transplant, including 22% using high failure methods including condoms, withdrawal, or rhythm. Women's reported preferences for counseling included discussion with transplant providers (92%), referral to women's health (67%), and handouts (31%). CONCLUSION: Reproductive counseling is inconsistent in liver transplant patients, despite patient interest, and the majority used no contraception. Given maternal and fetal risks of unplanned pregnancies, systems-based interventions that optimize women's preferred means of counseling should be implemented in this medically complex population.