Pregnancy and liver transplantation

Authors

  • Bijal Surti,

    1. Department of Medicine, UCLA Medical Center, Pfleger Liver Institute, University of California Los Angeles David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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  • Jennifer Tan,

    1. Department of Medicine, UCLA Medical Center, Pfleger Liver Institute, University of California Los Angeles David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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  • Sammy Saab

    1. Department of Medicine, UCLA Medical Center, Pfleger Liver Institute, University of California Los Angeles David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
    2. Department of Surgery, UCLA Medical Center, Pfleger Liver Institute, University of California Los Angeles David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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Correspondence
Sammy Saab, MD, MPH, AGAF, UCLA Medical Center, Pfleger Liver Institute, University of California Los Angeles David Geffen School of Medicine at UCLA, 200 Medical Plaza, Suite 214, Los Angeles, CA 90095, USA
Tel: +310 206 6705
Fax: +310 206 4197
e-mail: ssaab@mednet.ucla.edu

Abstract

Since the first pregnancy in a transplant recipient in 1958, pregnancy in recipients of solid organ transplants has become increasingly common. Although previously considered a hazardous event, data collected over the last 50 years demonstrate that despite an increased risk of maternal and fetal complications, pregnancy in transplant recipients can have a successful outcome. As of 2006, there were over 3000 female liver transplant recipients of childbearing age in the USA. Two hundred and two pregnancies and 205 outcomes were reported in 121 liver transplant recipients in the National Transplantation Pregnancy Registry. Children born to female liver recipients have a greater risk of prematurity and low birth weight than the general population, but no malformation patterns have been observed. Mothers are more likely to experience pregnancy-induced hypertension, pre-eclampsia and caesarian section, but overall mortality is not worse. Rates of acute rejection and graft loss are similar to nonpregnant liver recipients. The optimal timing of conception post-transplant is controversial, but current recommendations suggest waiting for at least 1 year after transplantation. Choice of contraception is also debatable, although barrier methods have traditionally been preferred. Many medications used for post-transplant immunosuppression have potential effects during pregnancy and breast-feeding. The risks and benefits of each medication should be reviewed with patients contemplating pregnancy, and regimens should be tailored accordingly.

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