Pregnancy following liver transplantation during childhood and adolescence

Abstract

More than 80% of pediatric transplant recipients will survive to reach adulthood, and many will consider having children. We report on outcomes and management of five pregnancies in four women undergoing orthotopic liver transplantation during childhood or adolescence and followed up at our Transplant Center. A retrospective clinical folder audit was performed. Mean age at transplantation was 13.3 ± 3.4 yr (range, 10-18 yr). Mean interval between transplantation and pregnancy was 15.4 ± 4.9 yr (range, 10-22 yr). Mean maternal age at conception was 28 ± 3.5 yr (range, 23-32 yr). Mean gestational age was 36.6 ± 1.7 wk. Mean birth weight was 2672 ± 249 g. Immunosuppression was cyclosporin based in three women and tacrolimus based in one woman. Pregnancy complications necessitating the induction of labor included fetal distress and rising maternal liver enzymes in two women, cholestasis of pregnancy and impaired renal graft function in one woman, fetal distress and preeclampsia in one woman. Modes of delivery were normal vaginal delivery in three women and cesarean section in one woman. No maternal or fetal deaths and no congenital malformations occurred. No episodes of rejection occurred during pregnancy. Two women experienced acute cellular rejection requiring an increase in baseline immunosuppression in the first year, following delivery. No graft losses occurred during a mean follow-up of 44 ± 17.9 months post-delivery. With careful management, pregnancy post-liver transplantation can have a successful outcome.

Reproductive Health and Liver Disease: Practice Guidance by the American Association for the Study of Liver Diseases

“…The number of pregnancies in LT recipients is rising, and reproductive health is a central issue among recipients of childbearing age. (407)(408)(409)(410) To best support reproductive intentions and help prevent unintentional pregnancies, transplant providers should discuss family planning with patients, ideally pre-LT and in the early postoperative period. Of the 543 pregnancies reported to the Transplant Pregnancy Registry International from November 1985 through May 2018, 40% were unplanned.…”

Infertility and ART after transplantation

“…More than 80% of paediatric OTr live to adulthood [25]. Infection (hepatitis C) or autoimmune diseases are present in most and, similar to ESRD patients, women with hepatic dysfunction often have HPO-axis disturbances with menstrual abnormalities.…”

Gynecologic laparoscopy in patients with prior renal transplantation: 3 cases

“…Artık günümüzde, modern immunosupresyon ve uygun gebelik takibi sonrasında sağlıklı gebelik sonuçları elde edileceği kabul edilmektedir. 6,7 Bizde bu vaka serisi ile, doğru hasta seçimi ve cerrahi teknikle renal transplantlı hasta grubunda da jinekolojik laparoskopinin uygun bir cerrahi modalitesi olabileceğini bildirmek istedik.…”