*Purpose: The purpose of this study is to describe twin pregnancy outcomes in female liver transplant recipients.

*Methods: Data were collected by the Transplant Pregnancy Registry International (TPR) via questionnaires, telephone interview and medical records review.

*Results: There are a total of over 1700 transplant recipients participating in the TPR. Included are 314 liver recipients (651 pregnancy outcomes), of whom 14 liver recipients reporting 16 twin pregnancies (32 pregnancy outcomes). There were 22 live births and 10 miscarriages; 4 miscarriages resulted in loss of 1 of the 2 fetuses and 3 resulted in the loss of both. All pregnancies occurred after a first liver transplant between Oct 1989 and Feb 2016. Use of reproductive assistance was reported for 9 conceptions (medication 1 and in vitro fertilization 8). Immunosuppression during pregnancy was cyclosporine-based during 3 and tacrolimus-based during 13; there were no exposures to mycophenolic acid products. Two recipients reported hypertension during pregnancy with no reports of preeclampsia or rejection during pregnancy or postpartum. There were no graft losses within 2 yrs postpartum. Cholestasis of pregnancy was reported during 4 pregnancies; in all cases the symptoms resolved after delivery. At a mean follow-up of 8.3± 3.4 yrs post pregnancy 1 recipient died 12.5 years after delivery (unknown cause), 1 recipient had reduced transplant function (relisted) and 12 (87.5%) recipients reported adequate function. Mean gestational age was 34.7±2.9 wks (range 31-37 wks) and mean birthweight was 2256±686 g (range 1531-4139 g). There were no neonatal deaths or reported birth defects. Eight children were breastfed. At a mean age of 8.4, at last follow-up all 22 children were reported healthy and developing well.

*Conclusions: Female liver transplant recipients can successfully maintain a pregnancy with a twin gestation with excellent long-term recipient, graft and child outcomes. The majority of these pregnancies occurred with utilization of reproductive techniques. Given the potential increased risk to the mother and fetuses in multiple gestation pregnancies, the favorable outcomes seen in these liver transplant recipients are reassuring.

« Back to 2020 American Transplant Congress