Pregnancy After Liver Transplantation

Coscia, Lisa A.; Davison, John M.; Moritz, Michael J.; Armenti, Vincent T.

doi:10.1007/978-3-319-05543-5_26-1

Cited by 3 publications

(4 citation statements)

References 75 publications

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“…Therefore, liver transplant recipients taking estrogen-based contraceptives could be exposed to a significant threat both short and long-term. This is the reason why our unit (like many others) usually contraindicates such drugs for at least 12 months post-transplantation and if we indicate them, then only in recipients with more than 6 months graft stability and in absence of other general contraindications (Coscia et al, 2015). Progestin-only-based alternatives are rated as CDC category 2 contraceptives with less contraindications in both complicated and uncomplicated patients (Deshpande et al, 2013) but they are also prone of adverse events and they are less effective than estrogenic preparations (Trussell, 2011).…”

Section: Risk To Benefit Considerations Contraceptives In Transplante...mentioning

confidence: 94%

“…Moreover, restoration of organ function after transplantation opens the possibility of full integration into normal life. Fertility compromised by renal or hepatic insufficiency is usually restored and maintained in young female transplant recipients shortly after surgery (Cundy et al, 1990, Coscia et al, 2015. Procreation ability and success has been recognized as a substantial factor contributing to the patient's quality of life after organ transplantation (Burra and De Bona, 2007), reflecting that parenthood is key to human realization and happiness.…”

Section: Fertility Considerations After Transplantationmentioning

confidence: 99%

“…This contraindication reflects the need for graft and patient overall clinical stabilization, the recovery from subjacent disease as well as from surgical intervention and for immunosuppressant minimization, rather than the physiological achievability of pregnancy. Time to conception inversely correlates with successful and complication-free obstetric, neonatal and transplantation outcomes (Coscia et al, 2015). The above-mentioned reasons lead most guidelines to make both pregnancy avoidance recommendation as well as evidence-based recommendations for post-transplant pregnancy suitability assessment.…”

Section: Fertility Considerations After Transplantationmentioning

confidence: 99%

“…Therefore, they cannot be assigned to a CDC category based on evidence. Guidelines do not consider them for this reason (McKay et al, 2005, Deshpande et al, 2013, Coscia et al, 2015, except Italian guideline that dismiss their usefulness (AISF, 2016) supporting their statement by a reference that neither speaks about fertility-awareness methods in transplantation nor provides any kind of evidence.…”

Section: Risk To Benefit Considerations Contraceptives In Transplante...mentioning

confidence: 99%

See 3 more Smart Citations

Applicability of biological fertility indicators for effective birth control after orthotopic liver transplantation

Huete

Castillo

Marcos

et al. 2019

Journal of Obstetrics and Gynaecology

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Section: Risk To Benefit Considerations Contraceptives In Transplante...mentioning

confidence: 94%

Section: Fertility Considerations After Transplantationmentioning

confidence: 99%

Section: Fertility Considerations After Transplantationmentioning

confidence: 99%

Section: Risk To Benefit Considerations Contraceptives In Transplante...mentioning

confidence: 99%

See 2 more Smart Citations

Applicability of biological fertility indicators for effective birth control after orthotopic liver transplantation

Huete

Castillo

Marcos

et al. 2019

Journal of Obstetrics and Gynaecology

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Pregnancy outcomes in female patients exposed to cyclosporin‐based versus tacrolimus‐based immunosuppressive regimens after liver/kidney transplantation: A systematic review and meta‐analysis

Yan

et al. 2021

J Clin Pharm Ther

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What is known and objective: Pregnancy after transplantation is a challenge owing to the high risk of adverse maternal and foetal outcomes, and immunosuppressants may further impact these outcomes. There are no head-to-head randomized controlled trials comparing influences of cyclosporin and tacrolimus on pregnancy outcomes. Thus, we systematically reviewed and meta-analysed observational studies assessing the comparative influences of these two drugs on pregnancy outcomes in liver/kidney transplant recipients. Methods:Relevant studies comparing pregnancy outcomes with tacrolimus and cyclosporin head-to-head were searched in PubMed, EMBASE and Web of Science (from 1 January 2000 to 20 March 2020). The weighted mean difference and odds ratio (OR) were calculated to compare continuous and dichotomous variables, respectively, with 95% confidence intervals (CIs). Publication bias was estimated using funnel plots. The study quality was assessed according to the modified Newcastle-Ottawa scale.Results and discussion: Overall, 10 observational studies of low quality, including a total of 1080 post-liver or kidney transplant pregnancies, were identified. Tacrolimustreated recipients experienced a lower risk of gestational hypertension (28.0%; OR: 1.74; 95% CI: 1.27-2.39; p < 0.01). Cyclosporin-treated recipients showed a lower incidence of caesarean section (40.3%; OR: 0.62; 95% CI: 0.46-0.82; p < 0.01).Additionally, cyclosporin performed better in terms of the live birth rate (78.0%; OR: 1.38; 95% CI: 1.02-1.88; p = 0.04). No significant differences in the incidences of preeclampsia, gestational diabetes, preterm delivery and birth weight were observed.What is new and conclusion: Tacrolimus performed better in patients with gestational hypertension, while cyclosporin was associated with a lower incidence of caesarean section and a higher incidence of live birth. The findings are based on relatively lowquality evidence, but may provide a reference for clinicians in their clinical monitoring and obstetric care for post-transplant pregnancies. | 745 GONG et al.

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Maternity After Orthotopic Liver Transplantation: Can the Use of Biological Fertility Indicators Help? Our Own Experience and Literature-based Recommendations

et al. 2022

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Over the last 5 decades, the fulfillment of maternity wishes in solid organ transplanted women has become a reality. Despite pregnancy contraindication in transplanted women during the early post-transplant period, such a condition can be overcome after 12 months if patients show a good clinical evolution and do not present other general pre-conceptional findings. This article presents the case report of a young female liver transplanted patient that used symptothermal method as a reliable family planning method. After her gestational contraindication was lifted, observation of biological fertility indicators and fertility-guided sexual intercourse helped her fulfill her maternity wish and conceive and carry out a healthy offspring. Based on this case and on the available bibliographic evidence, this paper reviews the potential implications of the use of this kind of approach as a safe and effective alternative to assisted reproduction technology in the management of potential infertility problems in the young female transplanted population, a population which according to literature has higher rates of unsuccessful parenthood and might also be more vulnerable to iatrogenicity of ovarian hyperstimulation process and to multiple pregnancy.

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Pregnancy After Liver Transplantation

Cited by 3 publications

References 75 publications

Applicability of biological fertility indicators for effective birth control after orthotopic liver transplantation

Applicability of biological fertility indicators for effective birth control after orthotopic liver transplantation

Pregnancy outcomes in female patients exposed to cyclosporin‐based versus tacrolimus‐based immunosuppressive regimens after liver/kidney transplantation: A systematic review and meta‐analysis

Maternity After Orthotopic Liver Transplantation: Can the Use of Biological Fertility Indicators Help? Our Own Experience and Literature-based Recommendations

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