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Women Delivering After Liver Transplant at the University of Washington: A Single Center Experience
Abstract Number: SAT-66
Abstract Type: Case Report/Case Series
Women of reproductive age account for 8% of the liver transplant (LTX) recipients, while girls, which eventually reach the reproductive age, account for 5%. The rise in patient survival increases the number of pregnancies after LTX. These pregnancies are considered high risk for maternal, fetal, and neonatal complications. Graft rejection, requiring an escalation of immunosuppressive therapy and re-LTX, can occur during (10-17%) or after (3-12%) pregnancy.
We reviewed electronic medical records of peri-partum outcomes after LTX since the inception of the transplant program in 1989 at UWMC. Outside hospital deliveries were excluded. Peri-partum laboratory values (liver, renal, hematological function, and immunosuppression regimen) were recorded. We also examined etiology, time to delivery after transplantation, type of obstetric anesthesia utilized, fetal outcomes, immediate post-partum complications and pain management.
5 women received a LTX and subsequently delivered 9 children at UWMC. Peri-partum laboratory values were normal in all women. Creatinine was slightly elevated in two women. Immunosuppression was exclusively achieved with the calcineurin inhibitor tacrolimus. All women required regional anesthesia for their deliveries. Two cases of post-partum hemorrhages were reported. No ICU care was needed. Three out of 5 women received acetaminophen and were discharged without delay. None of the women were diagnosed with pre-eclampsia (Table1).
Pregnancy can be safely completed after LTX. A 12-24 month waiting period is suggested until low dose immunosuppressive therapy and adequate allograft function are achieved; even though gonadal function returns earlier. A recent review found an increased incidence of pre-eclampsia, low birth weight and prematurity (1). In our series, no case of pre-eclampsia was found, but two newborns had low birth weight, one being a preterm delivery at 29 weeks. All other deliveries occurred at term. Monthly and, in the last 3rd trimester, weekly tacrolimus level monitoring is recommended to avoid toxic levels of unbound, active drug (2). Additionally, platelets, liver function and fetus growth need to be regularly followed, requiring an interdisciplinary team approach. Long-term effects on baby and graft outcome remain unknown to date and further studies are warranted.
1. Westbrook RH. Liver Transpl. 2015
2. Hebert MF. Transplantation. 2013