Cholestasis of pregnancy (COP) occurs in approximately 1% of pregnancies and is associated with increased risk of premature delivery. The purpose of this study was to describe pregnancy and graft outcomes in liver transplant recipients who reported COP. Data were collected via questionnaires, telephone interviews and medical record review. Of 222 recipients reporting 413 pregnancies and 427 outcomes to the National Transplantation Pregnancy Registry (NTPR), COP was reported in 25 pregnancies (6%). Outcomes of these pregnancies included 1 stillbirth at 24 wks due to placental abruption and 27 live births; 1 neonatal death. The neonatal death occurred at 16 days of age in the only infant in this group with 1st trimester exposure to mycophenolate mofetil who was born with multiple cardiac anomalies, microtia, absent corpus callosum, and facial dysmorphism. No other birth defects were reported in the other 26 live born. Immunosuppression during pregnancy was tacrolimus-based in 17 and cyclosporine-based in 8. Comorbid conditions reported during pregnancy: hypertension 12%, diabetes 12%, preeclampsia 18%, infections 24%, and rejection 8%. Two graft losses were reported within 2 yrs of pregnancy. At last maternal follow-up 7.7±6.1 yrs post-delivery, 17 recipients reported adequate function (3 retransplants), 2 reduced, and 2 had died (one at 15 yrs post-delivery of autoimmune hepatitis and the other 4 yrs post-delivery due to sepsis). The mean gestational age of the 27 live births was 34.9±3 wks (67% premature versus 40% in the overall liver NTPR database), the mean birthweight was 2503±740 g (41% low birthweight versus 30%), and 63% reported newborn complications (versus 35%). The notably higher rates of prematurity, low birth weight infants and newborn complications in this group may be attributable to early delivery due to COP. At last child follow-up at 6.5±6.1 yrs of age, all were reported healthy and developing well.

Conclusions: The incidence of cholestasis of pregnancy (COP) in liver transplant recipients reporting to the NTPR is six times higher than in the general population. However, recipients report that their COP symptoms resolve postpartum and none reported continuing transplant problems related to COP. Despite high rates of prematurity, no long-term effects on the offspring have been reported.

« Back to 2015 American Transplant Congress