The purpose of this study is to describe 544 pregnancies in 278 liver transplant recipients reporting to the Transplant Pregnancy Registry International (TPR) from 1991 to 2017. Data were collected via questionnaires, telephone interviews, and medical records review. The mean age at first transplant was 21±9 yrs (range 0.5-42). The mean interval from transplant to conception was 8±6.8 yrs. There was a two-fold increase in reporting of fertility issues (22%) compared to the general population (11%). 41% of pregnancies were unplanned. The majority of recipients were on calcineurin inhibitor therapy for immunosuppression, 37% on cyclosporine and 59% on tacrolimus; 6% of pregnancies were exposed to a mycophenolic acid product (MPA) during the first trimester. There were a total of 580 pregnancy outcomes (including multiples) resulting in 397 live births (71%), 132 miscarriages (24%), 18 terminations (3%), 8 stillbirths (1%) and 5 (1%) ectopic pregnancies. There were 34 1st trimester exposures to MPA resulting in 1 termination, 2 stillbirths, 21 miscarriages, 10 live births (3 with birth defects). Comorbid conditions during pregnancy included: hypertension 23%, preeclampsia 22%, cholestasis of pregnancy 18% (general population 1%), and rejection 3%. Graft loss within 2 yrs of delivery occurred in 3%. Mean gestational age of the live births was 36.6±3.4 wks and mean birthweight was 2744±785 g; 39% were preterm (<37 wks) and 31% were low birthweight (<2500 g). The birth defect rate was 5%, similar to the general population which ranges from 3-5%. The TPR has been following the children with a mean age of 9.3 yrs (age range, 0.01-30 yrs) and there are also 10 grandchildren.

Conclusions: Female liver transplant recipients have reported successful pregnancies, with an increased risk of premature and low birthweight infants. Cholestasis of pregnancy is much more common in this population. The risk of miscarriage and birth defects when pregnancies are exposed to MPA in utero underscores the need for pre-conception counseling. Infertility in liver transplant recipients requires additional study.

CITATION INFORMATION: Coscia L., Armenti D., Patel P., Constantinescu S., Moritz M. Outcomes of Pregnancies in Female Liver Transplant Recipients Am J Transplant. 2017;17 (suppl 3).

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