*Purpose: The purpose of this study is to describe 52 pregnancies in 39 lung transplant recipients reporting to the Transplant Pregnancy Registry International (TPRI) from 1992-2019; 3 recipients are from outside of North America.

*Methods: Data were collected via questionnaires, telephone interviews, and medical records review.

*Results: Cystic fibrosis was the indication for transplant in 22 (56%) of the women. The mean age at transplant was 27.5 ± 4.9 yrs and the transplant to conception interval was 4.0 ± 2.9 yrs (range 0.11-11.3 yrs). Only 41% of the pregnancies were reported as being planned. Most of recipients were on calcineurin inhibitor therapy for immunosuppression; 20% on cyclosporine and 78% on tacrolimus; 13% of pregnancies were exposed to a mycophenolic acid product (MPA) during the first trimester. Of the 54 pregnancies (including multiples) the outcomes were 33 live births, 15 miscarriages, 5 terminations, 0 stillbirths, and 1 ectopic pregnancy. There were 6 first trimester exposures to MPA resulting in 3 miscarriages, 2 live births (no birth defects) and 1 neonatal death due to prematurity (26 wks, also umbilical cord anomaly). Comorbid conditions during pregnancy included: hypertension 62%, rejection 14%, preeclampsia 12.5%, and diabetes requiring insulin 32%. Of the 33 livebirths the mean gestational age was 33.9 ± 4.8 wks and mean birthweight was 2151± 895 g. Neonatal deaths were reported in association with the triplet pregnancy: one fetus spontaneously aborted at 14 weeks, followed by the death of the two remaining infants delivered at 22 wks. There were 4 birth defects in 3 children. One child had both hypospadias (repaired at 8 mos) and cerebral arteriovenous malformation (corrected when discovered at age 18), one child had Tetralogy of Fallot, and one child had atrial and ventricular defects with pacemaker placement (mother had same diagnosis). There were 8 infants who were breastfed. The TPRI has been following the offspring long-term: mean age of the children 8.9 ± 8 yrs. With a mean maternal follow-up of 8.5 ± 7.3 yrs, 11 recipients have died (mean age of 6 children at maternal death 7.4 ± 5.7 yrs), 4 reported reduced function, and 24 had adequate transplant function.

*Conclusions: Successful pregnancy is possible after lung transplantation, though caution is advised as these are extremely high-risk pregnancies with high incidences of graft rejection, prematurity, low birthweight infants. Close surveillance of these recipients is warranted due to the negative impact of rejection during pregnancy on graft and long-term maternal survival. All centers worldwide are encouraged to have their recipients report all pregnancies to the TPRI.

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