The purpose of this study was to describe pregnancy outcomes in female liver recipients who received a transplant due to biliary atresia. Data were collected by the National Transplantation Pregnancy Registry (NTPR) via questionnaires, phone interviews and medical records. The NTPR has a total of 197 liver recipients reporting 355 pregnancies. Recipients transplanted for biliary atresia number 13 reporting 19 pregnancies. Eleven of the recipients reported having had a Kasai procedure prior to their transplant. The mean age at first transplant was 9.9±8.6 years, the mean age at conception was 24±4.9 years, and the mean transplant to conception interval was 10±6.1 years. Immunosuppression during pregnancy included: 11 tacrolimus (2 concomitant mycophenolic acid exposure [MPA]), 6 cyclosporine, and 2 with no immunosuppression. Pregnancy outcomes included: 17 live births, 1 spontaneous abortion (MPA exposure), and 1 stillbirth (placental abruption; no observed birth defects). Comorbid conditions during pregnancy included: hypertension 5%, diabetes 11%, preeclampsia 6%, infections 32% and rejection 5%. Mean gestational age was 35.6±2.9 wks; 9 infants were premature (<37 wks). Mean birthweight was 2549±731 g; 8 infants were low birthweight (<2500 g). There was 1 neonatal death due to multiple malformations (MPA exposure). At last child follow-up (mean 5.4±4.0 years), all 16 children were reported healthy and developing well. At last maternal follow-up (mean 5.7±4.2 years), 11 recipients reported adequate function (3 retransplanted) and 2 had reduced function.

Conclusions: We report relatively successful pregnancy outcomes in liver recipients transplanted for biliary atresia. Most of these women were transplanted as young children and have years of immunosuppressive exposure before pregnancy. The number of retransplants postpartum in this small group warrants further study. These pregnancies should be considered high-risk and monitored by an interdisciplinary team. Continued entries to the NTPR are encouraged from all centers.

Lee, D.: Grant/Research Support, Novartis Pharmaceuticals, Astellas Pharma US, Inc. Genentech, Inc. Pfizer Inc. Bristol-Myers Squibb, Sandoz and Teva. Coscia, L.: Grant/Research Support, Novartis Pharmaceuticals, Astellas Pharma US, Inc. Genentech, Inc. Pfizer Inc. Bristol-Myers Squibb, Sandoz and Teva. Armenti, V.: Grant/Research Support, Novartis Pharmaceuticals Corp. Astellas Pharma US, Inc. Genentech, Inc. Pfizer Inc. Bristol-Myers Squibb, Sandoz and Teva.

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