Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA.
Department of Surgery, Robert Wood Johnson Medical School, New Brunswick, NJ.
Liver Transpl. 2021 Sep;27(9):1262-1272. doi: 10.1002/lt.26098. Epub 2021 Jul 13.
Nearly half of living liver donors in North America are women of child-bearing age. Fetal and maternal outcomes after donation are unknown. We conducted a retrospective cohort study of female living liver donors (aged 18-50 years at donation) from 6 transplant centers. Participants were surveyed about their pregnancies and fertility. Outcomes were compared between predonation and postdonation pregnancies. Generalized estimating equations were clustered on donor and adjusted for age at pregnancy, parity, and pregnancy year. Among the 276 donors surveyed, 151 donors responded (54.7% response rate) and reported 313 pregnancies; 168/199 (68.8%) of the predonation pregnancies and 82/114 (71.9%) of the postdonation pregnancies resulted in live births, whereas 16.6% and 24.6% resulted in miscarriage, respectively. Women with postdonation pregnancies were older (32.0 versus 26.7 years; P < 0.001) and more frequently reported abnormal liver enzymes during pregnancy (3.5% versus 0.0%; P = 0.02) and delivery via cesarean delivery (35.4% versus 19.7%; P = 0.01). On adjusted analysis, there was no difference in cesarean delivery (odds ratio [OR], 2.44; 95% confidence interval [95% CI], 0.98-6.08), miscarriage (OR, 1.59; 95% CI, 0.78-3.24), combined endpoints of pregnancy-induced hypertension and preeclampsia (OR, 1.27; 95% CI, 0.36-4.49), or intrauterine growth restriction and preterm birth (OR, 0.91; 95% CI, 0.19-4.3). Of the 49 women who attempted pregnancy after donation, 11 (22.5%) self-reported infertility; however, 8/11 (72.7%) eventually had live births. Aside from increased reporting of abnormal liver enzymes and cesarean deliveries, there was no significant difference in pregnancy outcomes before and after living liver donation. One-fifth of women who attempt pregnancy after liver donation reported infertility, and although the majority went on to successful live births, further exploration is needed to understand the contributing factors. Future research should continue to monitor this patient-centered outcome across a large cohort of donors.
北美近一半的活体肝移植供者为育龄妇女。捐赠后胎儿和产妇的结局尚不清楚。我们对 6 个移植中心的 18-50 岁女性活体肝移植供者进行了回顾性队列研究。参与者接受了关于妊娠和生育能力的调查。比较了供者前和供者后妊娠的结局。使用广义估计方程对供者进行聚类，并根据妊娠时的年龄、产次和妊娠年份进行调整。在接受调查的 276 名供者中，有 151 名供者（54.7%的应答率）报告了 313 次妊娠；168/199 例（68.8%）供者前妊娠和 82/114 例（71.9%）供者后妊娠导致活产，而分别有 16.6%和 24.6%导致流产。有供者后妊娠的妇女年龄较大（32.0 岁比 26.7 岁；P<0.001），且妊娠期间更常报告肝功能异常（3.5%比 0.0%；P=0.02）和剖宫产分娩（35.4%比 19.7%；P=0.01）。在调整分析中，剖宫产分娩（比值比 [OR]，2.44；95%置信区间 [95%CI]，0.98-6.08）、流产（OR，1.59；95%CI，0.78-3.24）、妊娠高血压和子痫前期的联合终点（OR，1.27；95%CI，0.36-4.49）或宫内生长受限和早产（OR，0.91；95%CI，0.19-4.3）的差异无统计学意义。在 49 名尝试供者后妊娠的妇女中，有 11 名（22.5%）自我报告不孕；然而，最终有 8/11（72.7%）成功分娩。除了肝功能异常和剖宫产分娩的报告增加外，活体肝移植前后妊娠结局无显著差异。有五分之一尝试肝移植后妊娠的妇女报告不孕，尽管大多数最终成功分娩，但仍需要进一步研究以了解相关因素。未来的研究应继续监测这一以患者为中心的结果在大量供者中的情况。
