title: Preconception counseling, fertility, and pregnancy complications after abdominal organ transplantation: a survey and cohort study of 532 recipients.
abstract: BACKGROUND
  Pregnancy after solid organ transplant is a significant priority for transplant recipients but how patients report being counseled is unknown.
  
  
  METHODS
  We performed a single-center retrospective cohort study and telephone survey of female patients ages 18-49 at the time of kidney, pancreas, or liver transplant from 2000 to 2012 (n = 532). Data on pregnancy counseling, fertility, and maternal, fetal- and transplant-specific outcomes were collected. Multivariate Cox models assessed the impact of pregnancy on graft-specific outcomes.
  
  
  RESULTS
  The survey response rate was 29% (n = 152). One-third (n = 51) of women were actively counseled against pregnancy by one or more providers. A total of 17 pregnancies occurred among nine patients (5.9%), with 47% live births, 47% early embryonic demises, 5.9% stillbirths. Of live births, 50% were premature. Gestational complications, including diabetes, hypertension, and preeclampsia were present in 88% of mothers. Pregnancy after transplant was associated with higher rates of acute rejection than nulliparous transplant recipients (33% vs. 5.6%, p = 0.07) but did not significantly affect graft survival (HR = 1.00, 95% CI 0.99-1.01), after stratifying by organ and adjusting for clinical factors.
  
  
  CONCLUSIONS
  This study suggests that transplant patients are being counseled against pregnancy despite acceptable risks of complications and no specific effects on long-term graft function.
authors.affiliation: Section of Transplantation Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Devon M
authors.initials: DM
authors.lastname: Rupley
authors.forename: Allison M
authors.initials: AM
authors.lastname: Janda
authors.forename: Steven R
authors.initials: SR
authors.lastname: Kapeles
authors.forename: Tim M
authors.initials: TM
authors.lastname: Wilson
authors.forename: Deborah
authors.initials: D
authors.lastname: Berman
authors.forename: Amit K
authors.initials: AK
authors.lastname: Mathur
mesh_terms: D000293:Adolescent; D000328:Adult; D003376:Counseling; D005260:Female; D005298:Fertility; D005500:Follow-Up Studies; D006084:Graft Rejection; D006085:Graft Survival; D006306:Health Surveys; D006801:Humans; D016030:Kidney Transplantation; D016031:Liver Transplantation; D008875:Middle Aged; D016035:Pancreas Transplantation; D016742:Preconception Care; D011247:Pregnancy; D011248:Pregnancy Complications; D011256:Pregnancy Outcome; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors
keywords: abdominal organ; acute rejection after pregnancy; fertility in transplant patients; fetal outcomes; graft failure after pregnancy; preconception counseling; pregnancy after transplant; pregnancy outcomes; prenatal counseling; transplant