A comparison of the outcome of pregnancies after liver and kidney transplantation.

BACKGROUND

Pregnancies are an issue difficult to manage in recipients of solid organ grafts. Whereas most studies report on individual women who have received transplants, we retrospectively studied all gestations of women with liver (LT) or kidney transplants (KT) from October 1988 to August 2010 at one major transplantation center in Germany and compared the outcome.

METHODS

A total of 115 gestations in 37 women with LT and in 34 women with KT were identified. Mean age and time between transplantation and gestation were comparable in both groups.

RESULTS

Whereas 81 (70%) of all gestations were successful, 15 (13%) were terminated, and there were 19 (17%) spontaneous abortions and 2 (2%) intrauterine deaths. The rate of live births in women with LT was higher than that in women with KT (48/62 [77%] vs. 32/53 [62%], P=0.05). Fetal abnormalities were observed in two newborns in women with LT. The duration of successful gestations was lower in women with KT than in women with LT (35 months [range, 26-41 months] vs. 39 months [range, 26-40 months], P<0.001). Preterm births occurred in 37% of all women, but predominantly in women with KT associated with a lower birth weight of the newborns. Preeclampsia occurred in 18 women, of whom 14 were women with KT. We observed 10 women with rejection episodes associated to pregnancy; these were 8 women with LT and 2 women with KT.

CONCLUSIONS

Pregnancies after liver or kidney transplantation had an acceptable outcome with 70% live births. Remarkably, maternal comorbidity and complications during gestation were more frequent in women with KT affecting newborn birth weight. There were more rejections in women with LT than in women with KT.