*Purpose: Organ donation and liver transplantation can transform the lack of hope and a terrible loss into a gift – new life that springs from death. Sometimes, this gift has the potential to bring life multiple times, more than the one that is on the edge, waiting for the donor. We present the Romanian liver transplant pregnancy registry (RLTPR) as first step into the creation of a Romanian transplant pregnancy registry that will include all Romanian transplant recipients.

*Methods: RLTPR includes female patients from April 2000 (debut of Romanian LT program) until December 2020 (more than 1000 pts.) that underwent a liver transplant in Romania and successfully gave birth afterwards. Two patients were excluded being transplanted abroad, but gave birth to 3 Romanian healthy children.

*Results: 12 LT female recipients that gave birth to 13 children post transplantation were included. Mean mother age was 30 years old (21-38). LT indications were HBV cirrhosis (5), Wilson disease (4), primary biliary cholangitis, autoimmune cirrhosis and congenital hepatic fibrosis. In majority of cases tacrolimus based immunosuppression regimen was used (one case with cyclosporine) and corticoid was associated in only one case. Two recipients received right hemi livers from living donors, in all others cases whole liver grafts were used. Mean transplant-to-conception interval was 3.81 y.(1-7), and excepting two infectious episodes, and 3 miscarriages (18% – 7 and 8 wk.), no other complications occurred. 13 live births (82%) largely through cesarean section (84.6%) with a mean gestational age of 38.23 wk. (in only 7.6% premature) and with mean birthweight of 3325g. Neither birth defects nor neonatal deaths occurred, in only one newborn (41 wk. delivery) fever occurred but easily managed without antibiotics usage. Only one newborn was breastfed.

*Conclusions: Female liver transplants recipients had successful pregnancies without birth defects associated to Tacrolimus/Cyclosporine immunosuppression regimen, and partial graft usage had no impact. RLTPR will continue to collect and disseminate information to help recipients and healthcare providers make informed decisions about the advisability of pregnancy.

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