Safe pregnancy after liver transplantation: Evidence from a multicenter Italian collaborative study

Dig Liver Dis. 2022 May;54(5):669-675. doi: 10.1016/j.dld.2021.08.013. Epub 2021 Sep 5.

Abstract

Background: Women who have undergone liver transplantation (LT) enjoy better health, and possibility of childbearing. However, maternal and graft risks, optimal immunosuppression, and fetal outcome is still to clarify.

Aim: Aim of the study was to assess outcomes of pregnancy after LT at national level.

Methods: In 2019, under the auspices of the Permanent Transplant Committee of the Italian Association for the Study of the Liver, a multicenter survey including 14 Italian LT-centers was conducted aiming at evaluating the outcomes of recipients and newborns, and graft injury/function parameters during pregnancy in LT-recipients.

Results: Sixty-two pregnancies occurred in 60 LT-recipients between 1990 and 2018. Median age at the time of pregnancy was 31-years and median time from transplantation to conception was 8-years. During pregnancy, 4 recipients experienced maternal complications with hospital admission. Live-birth-rate was 100%. Prematurity occurred in 25/62 newborns, and 8/62 newborns had low-birth-weight. Cyclosporine was used in 16 and Tacrolimus in 37 pregnancies, with no different maternal or newborn outcomes. Low-birth-weight was correlated to high values of AST, ALT and GGT.

Conclusion: Pregnancy after LT has good outcome; however, maternal complications and prematurity may occur. Compliance with the immunosuppression is fundamental to ensure the stability of graft function and prevent graft-deterioration.

Keywords: Immunosuppression; Infertility; Liver transplantation; Pregnancy outcomes.

Publication types

  • Multicenter Study

MeSH terms

  • Cyclosporine
  • Female
  • Humans
  • Immunosuppressive Agents / therapeutic use
  • Infant, Newborn
  • Infant, Newborn, Diseases*
  • Liver Transplantation* / adverse effects
  • Pregnancy
  • Pregnancy Complications* / etiology
  • Pregnancy Outcome
  • Tacrolimus / therapeutic use

Substances

  • Immunosuppressive Agents
  • Cyclosporine
  • Tacrolimus