title: Pregnancy outcomes in liver transplant recipients: A 15-year single-center experience.
abstract: OBJECTIVE
  There are an increasing number of reports of pregnancy following liver transplantation, but many questions remain regarding preconception counseling and management of the pregnancy. The aim of this study was to report pregnancy outcomes in women who had undergone liver transplants and to gain insight into these issues.
  
  
  METHODS
  We conducted a retrospective review of liver transplant recipients who had received prenatal care at Kyoto University Hospital between January 2001 and December 2015.
  
  
  RESULTS
  Twenty-six consecutive pregnancies in 17 liver transplant recipients were identified during the period. The most common indication for liver transplantation was biliary atresia (65%). The median age at transplantation was 19 years (range, 2-38). The median age at conception was 28 years (range, 20-41) with a median time between transplantation and conception of 8 years (range, 0-22). A tacrolimus-based immunosuppressive regimen (n = 21, 81%) was the most common at the time of conception. There were 13 live births (50%), four spontaneous miscarriages (15%), and nine induced abortions (35%). Median gestational age at delivery was 38 weeks (range, 32-42), and the median birthweight was 2858 g (range, 1815-3864 g). Pregnancy and maternal complications included preterm deliveries (23%), intrauterine growth restriction (23%), pre-eclampsia (8%), cesarean delivery (23%), bacterial infection (15%), and biopsy-proven acute cellular rejection (15%). Two infants had congenital anomalies (tetralogy of Fallot and hydronephrosis).
  
  
  CONCLUSIONS
  Pregnancy after liver transplantation can achieve relatively favorable outcomes. Obstetricians should be involved in the contraceptive and fertility counseling of female transplant recipients to prevent unintended pregnancies.
authors.affiliation: Department of Gynaecology and Obstetrics, Kyoto University, Kyoto, Japan.
authors.forename: Yu
authors.initials: Y
authors.lastname: Kanzaki
authors.affiliation: Department of Gynaecology and Obstetrics, Kyoto University, Kyoto, Japan. kondo@kuhp.kyoto-u.ac.jp.
authors.forename: Eiji
authors.initials: E
authors.lastname: Kondoh
authors.affiliation: Department of Gynaecology and Obstetrics, Kyoto University, Kyoto, Japan.
authors.forename: Kaoru
authors.initials: K
authors.lastname: Kawasaki
authors.affiliation: Department of Gynaecology and Obstetrics, Kyoto University, Kyoto, Japan.
authors.forename: Haruta
authors.initials: H
authors.lastname: Mogami
authors.affiliation: Department of Gynaecology and Obstetrics, Kyoto University, Kyoto, Japan.
authors.forename: Yoshitsugu
authors.initials: Y
authors.lastname: Chigusa
authors.affiliation: Department of Gynaecology and Obstetrics, Kyoto University, Kyoto, Japan.
authors.forename: Ikuo
authors.initials: I
authors.lastname: Konishi
mesh_terms: D000028:Abortion, Induced / Q000706:statistics & numerical data; D000022:Abortion, Spontaneous / Q000453:epidemiology; D000328:Adult; D001724:Birth Weight; D005260:Female; D005865:Gestational Age; D006801:Humans; D007564:Japan; D016031:Liver Transplantation; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology*; D011256:Pregnancy Outcome / Q000453:epidemiology*; D012189:Retrospective Studies; D055815:Young Adult
keywords: liver transplantation; preconception counseling; pregnancy; rejection; unintended pregnancy