Jarvis Anna, Sheetz Miriam, Nayak Shriddha, Vaught Arthur, Toscano Marika, Darwin Kristin
Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD (Jarvis).
Department of Anesthesiology, Hospital for Special Surgery. New York, NY (Sheetz).
Am J Obstet Gynecol MFM. 2025 Jul;7(7):101696. doi: 10.1016/j.ajogmf.2025.101696. Epub 2025 May 10.
In 2023, 18,078 US women underwent solid organ transplants; over a third (n = 5547) were of reproductive age, receiving kidney (69.6%), liver (23.7%), or heart (9.0%) transplants. Successful pregnancies are feasible for transplant recipients, but these patients often face elevated pregnancy risks, including hypertension, gestational diabetes, pre-eclampsia, and preterm birth.
To determine rates of severe maternal morbidity (SMM) associated with prior kidney, liver, or heart transplant.
This descriptive study was conducted using the TriNetX Research Network, a health research network with data from 95 health care organizations spanning 1/1/2010-10/29/2024. Patients aged 12-55 years were included if they underwent single solid organ transplant prior to pregnancy and had no prior history of transplant rejection. Pregnancy was defined by delivery CPT code indicating presence of a pregnancy. SMM was defined using Centers for Disease Control (CDC) ICD-10 codes for 21 indicators of SMM. The primary outcome was composite SMM during delivery hospitalization or within one year postpartum. Secondary outcomes included comparison of SMM in individuals with and without solid organ transplant history, as well as estimation of rates of individual indicators of SMM and postpartum transplant rejection over time.
A total of 421 kidney, 192 liver, and 59 heart transplant recipients met inclusion criteria. Rates of composite SMM were greatest for heart transplant recipients (40.7%), with morbidity most often from pulmonary edema/acute heart failure (28.8%). This was followed by kidney transplant recipients (composite SMM 11.48%), with acute renal failure occurring in 9% of patients. Liver transplant recipients had the lowest composite SMM (7.48%). Rates of postpartum solid organ transplant rejection progressively increased at 1-, 2-, and 5-years post-delivery for all cohorts. Solid organ transplant rejection at 5-years was highest for heart transplant recipients (25.4%), followed by kidney (11.48%), and liver (7.48%).
Solid organ transplant recipients have significantly higher odds of composite SMM compared to pregnant non-transplant recipients. Among transplant recipients, patients with a history of heart transplant had the highest prevalence of composite non-transfusion SMM and highest rates of transplant rejection 5 years post-delivery. The impact of pregnancy on long-term outcomes in transplant recipients requires further study.
2023年，18078名美国女性接受了实体器官移植；超过三分之一（n = 5547）处于育龄期，接受了肾脏移植（69.6%）、肝脏移植（23.7%）或心脏移植（9.0%）。移植受者成功怀孕是可行的，但这些患者往往面临更高的妊娠风险，包括高血压、妊娠期糖尿病、先兆子痫和早产。
确定既往有肾脏、肝脏或心脏移植史的孕产妇严重并发症（SMM）发生率。
本描述性研究使用TriNetX研究网络进行，该健康研究网络拥有来自95个医疗保健机构的数据，时间跨度为2010年1月1日至2024年10月29日。纳入12 - 55岁的患者，这些患者在怀孕前接受了单一实体器官移植且无移植排斥史。妊娠通过分娩CPT代码定义，表明存在妊娠。SMM使用疾病控制中心（CDC）的ICD - 10代码定义21项SMM指标。主要结局是分娩住院期间或产后一年内的综合SMM。次要结局包括比较有和无实体器官移植史个体的SMM，以及估计SMM个体指标发生率和产后移植排斥随时间的变化情况。
共有421名肾脏移植受者、192名肝脏移植受者和59名心脏移植受者符合纳入标准。心脏移植受者的综合SMM发生率最高（40.7%），发病最常见于肺水肿/急性心力衰竭（28.8%）。其次是肾脏移植受者（综合SMM为11.48%），9%的患者发生急性肾衰竭。肝脏移植受者的综合SMM最低（7.48%）。所有队列在产后1年、2年和5年时，实体器官移植排斥率逐渐增加。5年时实体器官移植排斥率最高的是心脏移植受者（25.4%），其次是肾脏移植受者（11.48%），肝脏移植受者（7.48%）。
与未接受移植的孕妇相比，实体器官移植受者发生综合SMM的几率显著更高。在移植受者中，有心脏移植史的患者综合非输血性SMM患病率最高，且产后5年移植排斥率最高。妊娠对移植受者长期结局的影响需要进一步研究。
