Liver and Bile
Dig Liver Dis. 2022;54(5):669–75
Safe pregnancy after liver transplantation: Evidence from a multicenter Italian collaborative study
Background: Women who have undergone liver transplantation (LT) enjoy better health, and possibility of childbearing. However, maternal and graft risks, optimal immunosuppression, and fetal outcome is still to clarify.
Aim: Aim of the study was to assess outcomes of pregnancy after LT at national level.
Methods: In 2019, under the auspices of the Permanent Transplant Committee of the Italian Association for the Study of the Liver, a multicenter survey including 14 Italian LT-centers was conducted aiming at evaluating the outcomes of recipients and newborns, and graft injury/function parameters during pregnancy in LT-recipients.
Results: 62 pregnancies occurred in 60 LT-recipients between 1990 and 2018. Median age at the time of pregnancy was 31 years and median time from transplantation to conception was 8 years. During pregnancy, 4 recipients experienced maternal complications with hospital admission. Live birth-rate was 100%. Prematurity occurred in 25/62 newborns, and 8/62 newborns had low birth-weight. Cyclosporine was used in 16 and tacrolimus in 37 pregnancies, with no different maternal or newborn outcomes. Low-birth-weight was correlated to high values of aspartate aminotransferase, alanine aminotransferase and gamma glutamyl transferase.
Conclusion: Pregnancy after liver transplantation has good outcome; however, maternal complications and prematurity may occur. Compliance with the immunosuppression is fundamental to ensure the stability of graft function and prevent graft deterioration.