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Thursday, June 7, 2012

Successful Pregnancies Possible for Women Following Liver Transplantation

Recipients have Lower Miscarriage Risk and Higher Live Birth Rate than General U.S. Population 

New research confirms that successful pregnancies are common for female liver transplant recipients. The study appearing in the June issue of Liver Transplantation, a journal published by Wiley-Blackwell on behalf of the American Association for the Study of Liver Diseases, found miscarriage risk was lower and the live birth rate higher among women following liver transplantation than in the general U.S. population.

In 1978, Walcott et al. documented the first known pregnancy in a liver transplant recipient, which resulted in a successful delivery with both mother and infant in excellent health. Medical evidence reports there are currently 14,000 American women of reproductive age who have received liver transplants and another 500 undergo the procedure each year. While previous studies have documented good reproductive function in women following liver transplant, pregnancy outcomes and maternal-fetal risks assessments are limited.

For the present study, a team led by Dr. Dorry Segev, Director of Clinical Research in Transplant Surgery at Johns Hopkins Medical Institutions in Baltimore, Md., systematically reviewed medical literature articles from 2000 to 2011 to identify studies pertaining to pregnancy outcomes among liver transplant recipients. Maternal complications, delivery outcomes, birth information, and transplant-related data were also analyzed.

Eight studies met the inclusion criteria, which included 450 pregnancies among 306 liver transplant recipients. Following transplantation the live birth rate was 77% compared to 67% in birth in the general U.S. population. The rate was similar to the rate after kidney transplant at 77% and 74%, respectively. Miscarriages among women following kidney (14%) and liver (16%) transplants were lower than the general population (17%).

Rates for preeclampsia, cesarean section and preterm delivery were higher in liver transplant patients at 22%, 45%, and 39% than in the general population at 4%, 21% and 13%, respectively. Liver transplant recipients had lower pregnancy complications than kidney recipients whose rates for preeclampsia, C-section, and preterm delivery were 27%, 54%, and 46%, respectively. Liver transplant patients also had significantly greater delivery outcomes than kidney transplant recipients with the mean gestational age at 37 weeks versus 36 weeks, and infant birth weight at 6 pounds versus 5 pounds.

“Our findings confirm that pregnancy is feasible following liver transplantation, but not without potential complications,” said Neha Deshpande, who conducted the literature review. “Women who wish to start families following a liver transplant should work closely with their physicians to minimize risk and to ensure a healthy outcome for themselves and their babies.” The authors encourage transplant recipients to report pregnancy outcomes to transplantation centers for data collection.

In a related editorial, Dr. Vincent Armenti from Thomas Jefferson University in Philadelphia, Pa. writes, “Dr Segev and colleagues conclude that live birth outcomes are possible among liver transplant recipients and this favorable trend is consistent on the international level.” He also encourages reporting to active registries to monitor pregnancy and births in patients following liver transplantation.



Full citations: “Pregnancy Outcomes in Liver Transplant Recipients: A Systematic Review and Meta-Analysis.” Neha A. Deshpande, Nathan T. James, Lauren M. Kucirka, Brian J. Boyarsky,Jacqueline M. Garonzik-Wang, Andrew M. Cameron, Andrew L. Singer, Nabil N. Dagher, and Dorry L. Segev. Liver Transplantation ; Published Online: May 29, 2012 (DOI: 10.1002/lt.23416) Print Issue Date: June 2012. http://onlinelibrary.wiley.com/doi/10.1002/lt.23416/abstract.
Editorial: “Pregnancy Pregnancy after Liver Transplantation.” Vincent T. Armenti. Liver Transplantation; Published Online: May 29, 2012 (DOI: 10.1002/lt.23446) Print Issue Date: June 2012. http://onlinelibrary.wiley.com/doi/10.1002/lt.23446/abstract.
 

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