Pregnancy after liver transplantation: report of 8 new cases and review of the literature

Improved survival and quality of life following liver transplantation are associated with an increased frequency of pregnancies in liver-transplanted women. We investigated the outcome, complications, and management of those pregnancies. We have reviewed the literature and report 8 pregnancies in 6 transplant recipients. Seven pregnancies were completed at 38 ± 2 (mean ± standard deviation) weeks. One miscarriage occurred at week 12. Newborns' weight averaged 2938 ± 156 g. Main complications were preeclampsia (n = 1) and reversible cholestasis (n = 1). Among 285 pregnancies reported in literature, 78 ± 20% were successful and the main complications were: preeclampsia (26 ± 19%), hypertension (28 ± 19%), reversible liver dysfunction (27 ± 21%), cesarean delivery (23 ± 10%), preterm birth (31 ± 28%), small for gestational age infants (23 ± 10%), rejection (10 ± 7%). Gestational weeks were 36.7 ± 1.3, perinatal mortality was 4 ± 10%, malformation rate 3%. The rates of both abortions and complications (preeclampsia and/or hypertension) were inversely related to the time interval between transplantation and conception (p < 0.05). Abortions occurred more often in recipients whose underlying disease was autoimmune cirrhosis than in recipients with inherited disorders. Rejection rate was approx. 10%, which appears higher than reported in a non-pregnant population after a comparable time interval from transplant (2-3%). Up to 28 months after delivery, maternal death was 5.5 ± 7%. We conclude that: the time intervals between transplantation and conception as well as the original cause of liver failure influence the outcome and complications of pregnancies in liver recipients. However, neonatal survival is high, while malformations are relatively rare.