Reproductive health after thoracic transplantation: An ISHLT expert consensus statement

Michelle M Kittleson; Ersilia M DeFilippis; Catriona J Bhagra; Jillian P Casale; Matthew Cauldwell; Lisa A Coscia; Rohan D'Souza; Nicole Gaffney; Vicky Gerovasili; Patricia Ging; Kristin Horsley; Francesca Macera; Joan M Mastrobattista; Miranda A Paraskeva; Lynn R Punnoose; Kismet D Rasmusson; Quitterie Reynaud; Heather J Ross; Mitesh V Thakrar; Mary Norine Walsh

doi:10.1016/j.healun.2022.10.009

Reproductive health after thoracic transplantation: An ISHLT expert consensus statement

J Heart Lung Transplant. 2023 Mar;42(3):e1-e42. doi: 10.1016/j.healun.2022.10.009. Epub 2022 Oct 26.

Authors

Michelle M Kittleson¹, Ersilia M DeFilippis², Catriona J Bhagra³, Jillian P Casale⁴, Matthew Cauldwell⁵, Lisa A Coscia⁶, Rohan D'Souza⁷, Nicole Gaffney⁸, Vicky Gerovasili⁹, Patricia Ging¹⁰, Kristin Horsley¹¹, Francesca Macera¹², Joan M Mastrobattista¹³, Miranda A Paraskeva⁸, Lynn R Punnoose¹⁴, Kismet D Rasmusson¹⁵, Quitterie Reynaud¹⁶, Heather J Ross¹⁷, Mitesh V Thakrar¹⁸, Mary Norine Walsh¹⁹

Affiliations

¹ Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California. Electronic address: Michelle.kittleson@cshs.org.
² Division of Cardiology, New York Presbyterian-Columbia University Irving Medical Center, New York, New York.
³ Department of Cardiology, Cambridge University and Royal Papworth NHS Foundation Trusts, Cambridge, UK.
⁴ Department of Pharmacy Services, University of Maryland Medical Center, Baltimore, Maryland.
⁵ Department of Obstetrics, Maternal Medicine Service, St George's Hospital, London, UK.
⁶ Transplant Pregnancy Registry International, Gift of Life Institute, Philadelphia, Pennsylvania.
⁷ Division of Maternal and Fetal Medicine, Department of Obstetrics and Gynecology, McMaster University, Hamilton, Ontario, Canada.
⁸ Lung Transplant Service, Alfred Hospital, Melbourne, Australia; Department of Medicine, Central Clinical School, Monash University, Melbourne, Australia.
⁹ Heart and Lung Institute, Imperial College, London, UK.
¹⁰ Department of Pharmacy, Mater Misericordiae University Hospital, Dublin, Ireland.
¹¹ Department of Obstetrics and Gynecology, McMaster University, Hamilton, Ontario, Canada.
¹² De Gasperis Cardio Center and Transplant Center, Niguarda Hospital, Milan, Italy; Dept of Cardiology, Cliniques Universitaires de Bruxelles - Hôpital Erasme, Brussels, Belgium.
¹³ Department of Obstetrics & Gynecology, Division of Maternal-Fetal Medicine, Baylor College of Medicine Houston, Texas.
¹⁴ Vanderbilt Heart and Vascular Institute, Vanderbilt University Medical Center, Nashville, Tennessee.
¹⁵ Intermountain Medical Center Heart Institute, Salt Lake City, Utah.
¹⁶ Cystic Fibrosis Adult Referral Care Centre, Department of Internal Medicine, Hospices civils de Lyon, Pierre Bénite, France.
¹⁷ Peter Munk Cardiac Centre of the University Health Network, Toronto, Ontario, Canada; Ted Rogers Centre for Heart Research, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada.
¹⁸ Department of Medicine, Division of Respirology, University of Calgary, Calgary, Alberta, Canada.
¹⁹ St. Vincent Heart Center, Indianapolis, Indiana.

PMID: 36528467
DOI: 10.1016/j.healun.2022.10.009

Abstract

Pregnancy after thoracic organ transplantation is feasible for select individuals but requires multidisciplinary subspecialty care. Key components for a successful pregnancy after lung or heart transplantation include preconception and contraceptive planning, thorough risk stratification, optimization of maternal comorbidities and fetal health through careful monitoring, and open communication with shared decision-making. The goal of this consensus statement is to summarize the current evidence and provide guidance surrounding preconception counseling, patient risk assessment, medical management, maternal and fetal outcomes, obstetric management, and pharmacologic considerations.

Keywords: contraception; fertility; heart transplantation; lung transplantation; pregnancy.

Publication types

Practice Guideline

MeSH terms

Consensus
Counseling*
Female
Humans
Pregnancy
Reproductive Health*