Pregnancy After Transplantation
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What are the pregnancy outcomes among liver transplant recipients ?
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@pony Although reports show a good success rate of pregnancy in liver transplant recipients, these pregnancies carry high risk to the patient, fetus, and allograft and need to be closely monitored in specialized centers by an integrated team that includes a transplant hepatologist, a transplant surgeon, an obstetrician experienced in high-risk pregnancies, and a perinatologist or neonatologist.
Although planned pregnancy after liver transplantation is relatively common, acute liver failure during pregnancy is very uncommon, and acute liver failure requiring liver transplantation during early stages of pregnancy is rare. When abnormal liver function in a pregnant woman acts as a harbinger for acute liver failure, transplant hepatologists try to manage their care until the women are postpartum and, in some cases, might even induce birth as early as the 30th week before performing an orthotopic liver transplantation.
Complications in fertile, antepartum, and postpartum orthotopic liver transplant recipients include the following:
Maternal: Pregnancy-induced hypertension ; intrauterine infections, anemia, preeclampsia, cholestasis, pyelonephritis
Obstetric and delivery: Congenital CMV infection (highest in pregnancy occurring < 6 months after transplantation) ; perinatal infection with HBV (≤80%) or HCV (7%)
Fetal: Prematurity (40% of live births) ; intrauterine growth restriction (approximately 20%), prenatal infections, birth defects; immune suppression
Owing to a low rate of successful fetal delivery in case reports of antepartum liver transplantation, many hepatologists may be hesitant to select orthotopic liver transplantation as the treatment of choice in pregnant women with end-stage liver disease.