title: Outcomes of pregnancy following liver transplantation: The King's College Hospital experience.
abstract: Reports of pregnancy in liver transplantation (LT) patients have largely favorable outcomes. Concerns remain with regards to maternal and graft risk, optimal immunosuppression (IS), and fetal outcomes. We review all post-LT pregnancies at our center with regard to the outcomes and safety for the patient, graft, and fetus. A total of 117 conceptions occurred in 79 patients. Median age at conception was 29 years. Maternal complications included graft loss (2%), acute cellular rejection (ACR; 15%), pre-eclampsia/eclampsia (15%), gestational diabetes (7%), and bacterial sepsis (5%). ACR was significantly more common in those women who conceived within 12 months of LT (P = 0.001). The live birth rate was 73%. Prematurity occurred in 26 (31%) neonates, and 24 (29%) neonates were of low or very low birth weight. IS choice (cyclosporine versus tacrolimus) had no significant effect on pregnancy outcomes and complications. No congenital abnormalities occurred, and only 1 child born at 24 weeks had delayed developmental milestones. In conclusion, pregnancy following LT has a favorable outcome in the majority, but severe maternal risks remain. Patients should be counseled with regard to the above information so informed decisions can be made, and pregnancy must be considered high risk with regular monitoring by transplant clinicians and specialist obstetricians.
authors.affiliation: Institute of Liver Studies, King's College Hospital, National Health Service Foundation Trust, London, United Kingdom.
authors.forename: Rachel H
authors.initials: RH
authors.lastname: Westbrook
authors.affiliation: Institute of Liver Studies, King's College Hospital, National Health Service Foundation Trust, London, United Kingdom.
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Yeoman
authors.affiliation: Institute of Liver Studies, King's College Hospital, National Health Service Foundation Trust, London, United Kingdom.
authors.forename: Kosh
authors.initials: K
authors.lastname: Agarwal
authors.affiliation: Institute of Liver Studies, King's College Hospital, National Health Service Foundation Trust, London, United Kingdom.
authors.forename: Varuna
authors.initials: V
authors.lastname: Aluvihare
authors.affiliation: Institute of Liver Studies, King's College Hospital, National Health Service Foundation Trust, London, United Kingdom.
authors.forename: John
authors.initials: J
authors.lastname: O'Grady
authors.affiliation: Institute of Liver Studies, King's College Hospital, National Health Service Foundation Trust, London, United Kingdom.
authors.forename: Nigel
authors.initials: N
authors.lastname: Heaton
authors.affiliation: Institute of Liver Studies, King's College Hospital, National Health Service Foundation Trust, London, United Kingdom.
authors.forename: Leonie
authors.initials: L
authors.lastname: Penna
authors.affiliation: Institute of Liver Studies, King's College Hospital, National Health Service Foundation Trust, London, United Kingdom.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Heneghan
mesh_terms: D000328:Adult; D064591:Allografts; D002658:Developmental Disabilities / Q000175:diagnosis / Q000209:etiology; D005260:Female; D006084:Graft Rejection / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality; D006085:Graft Survival; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects; D050498:Live Birth; D016031:Liver Transplantation / Q000009:adverse effects / Q000401:mortality; D008131:London; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality; D018873:Pregnancy Rate; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents