Surveillance of pregnancy in women following non-renal solid organ transplant
Despite initial concerns about the advisability of pregnancy in women who have had transplants, there have now been reports of over 14,000 births to women with transplants. Three voluntary registers have collected information at various times: the US National Transplantation Pregnancy Register (1991-present), the UK Transplant Pregnancy Register (1994-2001) and the European Dialysis and Transplant Association Registry (1960-1992). Increasing numbers of pregnancies are now occurring in women who have had solid organ transplants other than kidneys, such as liver, heart and lung. However, the published information is insufficient to assess with confidence the outcomes of these pregnancies. This information is important in counselling and managing these women prior to and during pregnancy. The UK Transplant Register ceased to collect data in 2001. Drug treatments to prevent transplant rejection are continually developing, and more information is needed about the effects of these drugs on the mother and her infant. This project, using the UK Obstetric Surveillance System (UKOSS) collected information about pregnancy and any associated illnesses amongst women who had a solid organ transplant (excluding kidney).
The majority of studies reporting outcomes in transplant recipients have focused on women with kidney transplants, and have included retrospective, voluntary registries or single centre studies.
- The aim of this study was to use UKOSS to conduct a national, prospective cohort study of pregnancy outcomes in liver and cardiothoracic transplant recipients.
- There were 62 pregnancies in 56 liver transplant recipients and 14 pregnancies in 14 cardiothoracic transplant recipients (including 10 heart, three lung and one heart-lung recipient) between January 2007 and January 2012.
- Liver transplant recipients, in comparison to cardiothoracic, had similar livebirth rates (92% vs. 87%) but better fetal outcomes (median gestational age 38 weeks vs. 35 weeks; median birthweight 2698g vs. 2365g), fewer caesarean deliveries (47% vs. 62%), fewer maternal intensive care (ICU) admissions (19% vs. 29%) and fewer neonatal ICU admissions (25% vs. 54%).
- Nine women (12%) were taking mycophenolate mofetil at conception, which was associated with adverse fetal outcomes.
- This study shows that pregnancy in transplant recipients may have successful outcomes, but complication rates are high, emphasising the role of pre-conception counselling and further research into the long-term effects on maternal and graft survival rates.