Infertility is common in women with end-stage liver disease.
Successful liver transplant, however, can restore childbearing potential.
Controversy exists regarding the most appropriate immunosuppressive regimen and timing of conception following liver transplant.
Dr Christopher Vimala and colleagues from England reported the outcomes of a review of all pregnancies occurring after liver transplant from 1988 to 2004.
The team recorded 71 pregnancies in 45 women.
Tacrolimus and cyclosporin A were the predominant primary immunosuppressive agents used.
Median age at conception was 29 years, with a median time from liver transplant to conception of 40 months.
There were 50 live births, and no maternal or fetal deaths related to pregnancy.
The research team observed no graft losses.
Median gestation was 37 weeks with a median birth weight of 2690 g.
The researchers performed cesarean section in 40% of pregnancies.
| Complications included pregnancy-induced hypertension in 20%|
Complications included pregnancy-induced hypertension in 20%, preeclampsia in 13%, acute cellular rejection in 17%, and renal impairment in 11%.
There was no statistically significant difference in complication rates observed between immunosuppressive groups.
The team noted that pregnancies occurring within 1-year posttransplant had an increased incidence of prematurity.
There was also an increased incidence of low birth weight, and acute cellular rejection compared to those occurring later than 1 year.
Dr Vimala's concludes, “This study confirms that favorable outcomes of pregnancy post-liver transplant can be expected for the majority of patients.”
“However, delaying pregnancy until after 1-year post-liver transplant is advisable, since doing so maybe associated with a lower risk of prematurity.”