[Contraception and pregnancy after liver transplantation: an update overview].
BACKGROUND
Successful liver transplantation not only treats the underlying liver disease but also restores libido and fertility in female recipients. Although reports of successful pregnancy after liver transplantation continue to increase, these pregnancies are considered of high-risk because they are associated with increase maternofetal morbidity.


METHODS
A MEDLINE search (1978-2007) was conducted using the terms 'liver transplantation', 'pregnancy', 'immunosuppressive agents', 'sexual function'. Reviews, retrospective series, long-term clinical follow-up of case series and original articles containing basic scientific observations were included.


RESULTS
Although no formal guidelines have been established there are some 'golden rules' to improve the probability of favorable maternal and fetal outcome. Most transplant centers recommend to delay pregnancy for at least 1-year after transplantation. The recipient should be on a stable immunosuppression regimen, with good graft function and no evidence of renal dysfunction or uncontrolled arterial hypertension. Considering the increased incidence of prematurity, low birth weight, hypertension and preeclampsia reported during pregnancy post-LT, these high-risk patients should be managed by a multidisciplinary team, including an obstetrician specialized in high-risk pregnancies. Carefully monitoring of immunosuppressive drugs serum level is prudent to avoid graft rejection episodes and drugs with teratogenic potential should be discontinued. Breastfeeding is usually not recommended.


CONCLUSIONS
Successful pregnancies are the rule after liver transplantation. A carefully monitoring by an experience multidisciplinary team increases the chances of favorable maternofetal outcome.
Parolin
Mônica Beatriz
MB
Serviço de Transplante Hepático, Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, PR. mbparolin@hotmail.com
Coelho
Júlio Cezar Uili
JC
Urbanetz
Almir Antônio
AA
Pampuch
Melina
M
D003267:Contraception; D005260:Female; D006801:Humans; D007165:Immunosuppression Therapy / Q000009:adverse effects; D016031:Liver Transplantation / Q000502:physiology*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000139:chemically induced / Q000517:prevention & control*; D011256:Pregnancy Outcome; D018566:Pregnancy, High-Risk / Q000187:drug effects / Q000502:physiology*; D013997:Time Factors