Association of pregnancy complications and choice of immunosuppressant in liver transplant patients.
BACKGROUND
The purpose of this study was to identify factors associated with antenatal complications for an ongoing series of pregnant women who have undergone orthotopic liver transplantation.


METHODS
We reviewed Magee-Womens Hospital records from 14 pregnancies in 13 women in whom a liver had been transplanted before pregnancy. We collected and analyzed data regarding the primary liver disease, allograft status, liver function at conception and during pregnancy, immunosuppressive medications, associated medical conditions, time from transplant to conception, cytomegalovirus serostatus, and maternal and fetal outcome.


RESULTS
Seven patients had evidence of renal dysfunction (creatinine, 1.3-2.0 mg/dl), five of whom also were hypertensive at their first prenatal visit. The complications of preeclampsia, worsening hypertension, and small for gestational age occurred only in women with renal dysfunction at conception. Renal dysfunction was more often associated with cyclosporine than tacrolimus use.


CONCLUSIONS
Renal dysfunction is the primary determinant of adverse pregnancy outcome in liver transplant recipients. Immunosuppression with cyclosporine during pregnancy was more often associated with antenatal complications than with the use of tacrolimus.
Casele
H L
HL
University of Pittsburgh Health Sciences Center, Department of Obstetrics, Gynecology and Reproductive Sciences, Pennsylvania 15213, USA.
Laifer
S A
SA
D000740:Anemia / Q000453:epidemiology; D016640:Diabetes, Gestational / Q000453:epidemiology; D005260:Female; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007231:Infant, Newborn; D007674:Kidney Diseases / Q000453:epidemiology; D008111:Liver Function Tests; D016031:Liver Transplantation / Q000276:immunology / Q000502:physiology*; D007752:Obstetric Labor, Premature / Q000453:epidemiology; D011225:Pre-Eclampsia / Q000453:epidemiology; D011247:Pregnancy; D011248:Pregnancy Complications / Q000145:classification / Q000453:epidemiology*; D012189:Retrospective Studies; D012307:Risk Factors
D007166:Immunosuppressive Agents