Long-term maternal outcomes of pregnancy after orthotopic liver transplantation in the Netherlands: a retrospective multicenter cohort study

Meinderts, J.R.; Metselaar, H.J.; Hoek, B. van; Hoed, C.M. den; Rijntjes, D.; Groenewout, M.; ... ; Jong, M.F.C. de (2024)

Article / Letter to editor

Pregnancy after orthotopic liver transplantation (OLT) puts the mother, child, and transplanted organ at risk. Little is known about long-term outcomes. We performed a nationwide retrospective cohort study to evaluate short-term and long-term outcomes of post-OLT pregnancies. The secondary aim was to assess predictors for adverse pregnancy outcomes. A composite outcome of preeclampsia, preterm birth, low birth weight, and neonatal intensive care unit admission was made. Survival of women who received a transplant at <50 years of age with and without pregnancy after OLT were compared (Dutch Organ Transplantation Registry data). Descriptive statistics, regression analysis, Kaplan-Meier and log-rank analysis, and generalized estimating equation analysis were used. Among the included 70 women with 113 pregnancies >20 weeks of gestation, hypertension occurred in 20% and preeclampsia in 12%. The live birth rate was 87%; 33% were preterm, and 23% had low birth weight. Long-term follow-up (median 10 y [IQR: = 4–14]) showed small changes in serum creatinine and bilirubin (p < 0.001). Sixteen mothers (23%) died during follow-up (median 8 y [IQR: = 4–12]), with all their children aged <18 years. No difference in survival was found when comparing women with and without pregnancy after OLT. The composite outcome occurred in 43/98 of pregnancies. Higher body mass index (BMI) and maternal age at conception increased the composite outcome risk (OR: 1.24, p < 0.01, and OR: 1.25, p = 0.01, respectively). To conclude, pregnancy after OLT does not seem to influence long-term outcomes of graft, kidney function, or patient survival in most cases. However, although pregnancy does not seem to impact survival after OLT, we do show that a substantial number of children will lose their mothers early in life. We believe this is important for pregnancy couseling of patients with an OLT and their partners.

• graft function
• kidney function
• liver transplantation
• long-term outcome
• pregnancy
• pregnancy complications
• survival

• All authors: Meinderts, J.R.; Metselaar, H.J.; Hoek, B. van; Hoed, C.M. den; Rijntjes, D.; Groenewout, M.; Vilsteren, F.G.I. van; Groen, H.; Berger, S.P.; Prins, J.R.; Jong, M.F.C. de
• Date: 2024-09-10
• Journal: Liver Transplantation
• DOI: doi:10.1097/LVT.0000000000000477