Orthotopic liver transplant in the pregnant recipient: A systematic review of preoperative management and maternal and fetal outcomes

Abstract

Liver transplantation is an effective, often curative treatment for end-stage liver disease, acute liver failure, and primary hepatic malignancy. [1][2][3][4] Since 2012, the number of liver transplants performed annually has increased, with 8,896 performed nationally in 2019. 5 Women constitute 37% of patients who have had liver transplantation, with about 12% being of reproductive age (18-49 years old).Another 5% are pediatric female liver transplant recipients, who have > 80% survival into adulthood and thus may likely consider pregnancy. 5,6 Since the first pregnancy in a liver transplant recipient in 1978, outcomes for both mother and fetus have greatly improved. Recent studies report a 20-year maternal survival rate of 53% and a live birth rate of 75% 7,8 in patients who became pregnant after liver transplantation. With advancements in transplant immunosuppression, organ preservation, and donor and recipient transplantation surgical techniques, female liver transplant recipients are generally able to plan a safe pregnancy by 1-2 years after transplant. 9While there is robust literature about patients having successful pregnancies after liver transplant, few studies discuss liver transplantation during pregnancy. To our knowledge, there has been no consensus on the expected outcomes of these patients and their fetuses, nor a discussion of the optimal perioperative management of pregnant patients undergoing liver transplant. The purpose of this study was to perform a systematic review of the literature analyzing the clinical outcomes of these patients and their fetuses, the etiologies leading to liver transplant during pregnancy, and the anesthetic management of liver transplantation during pregnancy.