Division of Maternal and Fetal Medicine, Department of Obstetrics & Gynaecology, Mount Sinai Hospital, University of Toronto, Canada.
Department of Obstetrics and Gynecology, University Hospital Leuven, Leuven, Belgium.
Liver Transpl. 2018 Jun;24(6):769-778. doi: 10.1002/lt.25071.
Due to advances in obstetric and transplant medicine, women with a history of liver transplantation can have successful pregnancies. However, data on pregnancy outcomes is still limited, especially for women who have had a repeat liver transplant following graft rejection. This retrospective study compares pregnancy outcomes in women with single and repeat liver transplants managed at 2 tertiary hospitals in Toronto, Canada and Leuven, Belgium. We identified 41 pregnancies in 28 transplanted women, 6 of whom conceived following a second liver transplant after the first was rejected. Mean maternal age at delivery was 30 ± 7 years, and transplant-to-pregnancy interval was 8.5 ± 5.1 years. All women had normal liver function upon conception. Immunosuppressants included tacrolimus ± azathioprine (n = 26), cyclosporine (n = 4), and prednisone with immunosuppressants (n = 11). There were no maternal deaths. Maternal complications included hypertensive disorders of pregnancy (n = 10), deterioration in renal function (n = 6), gestational diabetes (n = 4), graft deterioration (n = 2), and anemia requiring blood transfusion (n = 1). Fetal/neonatal adverse outcomes included 2 miscarriages, 3 stillbirths, 1 neonatal death, 5 small-for-gestational-age infants, and 1 minor congenital anomaly. Mean gestational age at delivery was 36.7 ± 4.2 weeks. There were 14 (38.9%) preterm births. Outcomes in women with a second transplant were similar to those with a single transplant, except for a higher incidence of hypertensive disorders. In conclusion, with appropriate multidisciplinary care, stable graft function at pregnancy onset, and adherence to immunosuppressive regimens, women with single and repeat liver transplants have low rates of graft complications but remain at increased risk for pregnancy complications. Immunosuppressants and high-dose glucocorticoids can be safely used for maintenance of graft function and management of graft deterioration in pregnancy. Liver Transplantation 24 769-778 2018 AASLD.
由于产科和移植医学的进步，有肝移植史的女性可以成功怀孕。然而，关于妊娠结局的数据仍然有限，特别是对于那些在移植物排斥后进行再次肝移植的女性。这项回顾性研究比较了在加拿大多伦多和比利时鲁汶的 2 家三级医院接受治疗的单器官和再次肝移植女性的妊娠结局。我们在 28 名接受过肝移植的女性中发现了 41 例妊娠，其中 6 例在第一次肝移植失败后进行了第二次肝移植后怀孕。分娩时产妇的平均年龄为 30 ± 7 岁，移植至妊娠的间隔时间为 8.5 ± 5.1 年。所有女性在受孕时肝功能均正常。免疫抑制剂包括他克莫司+硫唑嘌呤（n = 26）、环孢素（n = 4）和泼尼松加免疫抑制剂（n = 11）。无产妇死亡。产妇并发症包括妊娠高血压疾病（n = 10）、肾功能恶化（n = 6）、妊娠期糖尿病（n = 4）、移植物恶化（n = 2）和需要输血的贫血（n = 1）。胎儿/新生儿不良结局包括 2 例流产、3 例死胎、1 例新生儿死亡、5 例小于胎龄儿和 1 例轻微先天畸形。分娩时的平均孕龄为 36.7 ± 4.2 周。有 14 例（38.9%）早产。再次移植的女性与单次移植的女性结局相似，除了高血压疾病的发生率较高。总之，在适当的多学科护理下，妊娠起始时移植物功能稳定，且遵循免疫抑制方案，单次和再次肝移植的女性移植物并发症发生率较低，但妊娠并发症的风险仍然增加。免疫抑制剂和大剂量糖皮质激素可安全用于维持移植物功能和治疗妊娠期间的移植物恶化。肝脏移植 24 769-778 2018 AASLD。
