Liver Unit, Division of Gastroenterology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada.
Liver Transpl. 2010 Jan;16(1):56-63. doi: 10.1002/lt.21906.
Liver transplant recipients and their infants may have an increased risk of obstetric complications. Our objective was to describe pregnancy outcomes in women with a prior transplant from a population-based perspective. We analyzed the 1993-2005 US Nationwide Inpatient Sample database to identify obstetric hospitalizations among transplant recipients (n = 206) and controls matched by age, hospital, and year (n = 4060). The effect of prior transplantation on maternal and fetal outcomes was evaluated with regression models with adjustments for patient and hospital factors, including admission to a transplant center. Between 1993 and 2005, 146 delivery admissions among liver transplant recipients were identified. Cesarean deliveries were more common among transplant recipients (38% versus 24%; P = 0.0001); however, this difference was not significant after multivariate adjustment [OR (odds ratio) = 0.87; 95% confidence interval (CI) = 0.60-1.27]. Maternal mortality was similar among cases and controls (0% versus 0.02%; P = 1.00), but transplant patients had higher rates of fetal mortality (6.3% versus 2.0%; P = 0.0006), antepartum admission (OR = 2.27; 95% CI = 1.59-3.25), and maternal (OR = 2.63; 95% CI = 1.82-3.80) and fetal complications (OR = 2.49; 95% CI = 1.68-3.70). Gestational hypertension (30% versus 9%; P < 0.0001) and postpartum hemorrhage (8% versus 3%; P = 0.009) were more common among transplant recipients; their infants had higher rates of prematurity (27% versus 11%; P < 0.0001), distress (10% versus 5%; P = 0.005), and growth restriction (5% versus 2%; P = 0.05) but not congenital anomalies. Hospitalization in a transplant center ( approximately 50%) was associated with similar obstetric outcomes. In conclusion, although most pregnancy outcomes are favorable, liver transplant recipients and their infants have an increased risk of obstetric complications. Additional studies evaluating mechanisms aimed at reducing these complications are necessary.
肝移植受者及其婴儿可能面临更高的产科并发症风险。本研究旨在从人群角度描述有肝移植史的女性的妊娠结局。我们分析了 1993 年至 2005 年美国全国住院患者样本数据库，以确定肝移植受者（n=206）和按年龄、医院和年份匹配的对照者（n=4060）中的产科住院情况。通过调整患者和医院因素（包括是否收入移植中心）的回归模型，评估了先前移植对母婴结局的影响。1993 年至 2005 年期间，我们确定了 146 例分娩住院病例。肝移植受者的剖宫产率更高（38%比 24%；P=0.0001）；但多变量调整后差异无统计学意义[比值比（OR）=0.87；95%置信区间（CI）=0.60-1.27]。病例组和对照组的产妇死亡率相似（0%比 0.02%；P=1.00），但移植患者的胎儿死亡率更高（6.3%比 2.0%；P=0.0006）、产前入院率更高（OR=2.27；95%CI=1.59-3.25）、产妇并发症（OR=2.63；95%CI=1.82-3.80）和胎儿并发症（OR=2.49；95%CI=1.68-3.70）发生率更高。肝移植受者的妊娠高血压（30%比 9%；P<0.0001）和产后出血（8%比 3%；P=0.009）更为常见；其婴儿的早产率（27%比 11%；P<0.0001）、窘迫发生率（10%比 5%；P=0.005）和生长受限发生率（5%比 2%；P=0.05）更高，但先天性异常发生率无差异。收入移植中心（约 50%）与相似的产科结局相关。总之，虽然大多数妊娠结局良好，但肝移植受者及其婴儿产科并发症风险增加。需要进一步研究评估旨在降低这些并发症的机制。
