title: Pregnancy after heart and lung transplantation.
abstract: Patients awaiting transplantation should be counseled regarding posttransplant contraception and the potential adverse outcomes associated with posttransplant conception. Pregnancy should be avoided for at least 1-2 years post transplant to minimize the risks to allograft function and fetal well-being. Transplant patients, particularly lung transplant recipients, have an increased risk of maternal and neonatal pregnancy-related complications, including prematurity and low birth weight, postpartum graft loss, and long-term morbidity and mortality compared to other solid-organ recipients. Therefore, careful monitoring by a specialized transplant team is crucial. Maintenance of immunosuppression is recommended, except for mycophenolate and mammalian target of rapamycin inhibitors (mTORi), which should be replaced before conception. Immunosuppressants must be regularly monitored and dosing adjusted to avoid graft rejection. Monitoring during labor is mandatory and epidural anesthesia recommended. Vaginal delivery should be standard and cesarean delivery only performed for obstetric reasons. Breastfeeding poses risks of neonatal exposure to immunosuppressants and is generally contraindicated.
authors.affiliation: KU Leuven - University of Leuven, Department of Clinical and Experimental Medicine, Division of Pneumology, Lung Transplant Unit, B-3000 Leuven, Belgium; KU Leuven - University of Leuven, University Hospitals Leuven, Department of Respiratory Medicine, Lung Transplant Unit, B-3000 Leuven, Belgium. Electronic address: robin.vos@uzleuven.be.
authors.forename: Robin
authors.initials: R
authors.lastname: Vos
authors.affiliation: KU Leuven - University of Leuven, Department of Clinical and Experimental Medicine, Division of Pneumology, Lung Transplant Unit, B-3000 Leuven, Belgium; KU Leuven - University of Leuven, University Hospitals Leuven, Department of Respiratory Medicine, Lung Transplant Unit, B-3000 Leuven, Belgium.
authors.forename: David
authors.initials: D
authors.lastname: Ruttens
authors.affiliation: KU Leuven - University of Leuven, Department of Clinical and Experimental Medicine, Division of Pneumology, Lung Transplant Unit, B-3000 Leuven, Belgium; KU Leuven - University of Leuven, University Hospitals Leuven, Department of Respiratory Medicine, Lung Transplant Unit, B-3000 Leuven, Belgium.
authors.forename: Stijn E
authors.initials: SE
authors.lastname: Verleden
authors.affiliation: KU Leuven - University of Leuven, Department of Clinical and Experimental Medicine, Division of Pneumology, Lung Transplant Unit, B-3000 Leuven, Belgium; KU Leuven - University of Leuven, University Hospitals Leuven, Department of Respiratory Medicine, Lung Transplant Unit, B-3000 Leuven, Belgium.
authors.forename: Elly
authors.initials: E
authors.lastname: Vandermeulen
authors.affiliation: KU Leuven - University of Leuven, Department of Clinical and Experimental Medicine, Division of Pneumology, Lung Transplant Unit, B-3000 Leuven, Belgium; KU Leuven - University of Leuven, University Hospitals Leuven, Department of Respiratory Medicine, Lung Transplant Unit, B-3000 Leuven, Belgium.
authors.forename: Hannelore
authors.initials: H
authors.lastname: Bellon
authors.affiliation: KU Leuven - University of Leuven, Department of Clinical and Experimental Medicine, Division of Pneumology, Lung Transplant Unit, B-3000 Leuven, Belgium; KU Leuven - University of Leuven, University Hospitals Leuven, Department of Respiratory Medicine, Lung Transplant Unit, B-3000 Leuven, Belgium.
authors.forename: Bart M
authors.initials: BM
authors.lastname: Vanaudenaerde
authors.affiliation: KU Leuven - University of Leuven, Department of Clinical and Experimental Medicine, Division of Pneumology, Lung Transplant Unit, B-3000 Leuven, Belgium; KU Leuven - University of Leuven, University Hospitals Leuven, Department of Respiratory Medicine, Lung Transplant Unit, B-3000 Leuven, Belgium.
authors.forename: Geert M
authors.initials: GM
authors.lastname: Verleden
mesh_terms: D005260:Female; D006084:Graft Rejection / Q000517:prevention & control; D016027:Heart Transplantation; D006801:Humans; D007165:Immunosuppression Therapy / Q000009:adverse effects; D007231:Infant, Newborn; D016040:Lung Transplantation; D008991:Monitoring, Physiologic; D011225:Pre-Eclampsia / Q000517:prevention & control; D011247:Pregnancy; D011248:Pregnancy Complications / Q000517:prevention & control*; D011256:Pregnancy Outcome
keywords: heart transplantation; lung transplantation; pregnancy