Long-term maternal outcomes of pregnancy after orthotopic liver transplantation in the Netherlands - a retrospective multicenter cohort study

Pregnancy after orthotopic liver transplantation (OLT) puts mother, child and transplanted organ at risk. Little is known about long-term outcomes. We performed a nation-wide retrospective cohort study to evaluate short- and long-term outcomes of post-OLT pregnancies. Secondary aim was to assess predictors for adverse pregnancy outcomes. A composite outcome of preeclampsia, preterm birth, low birth weight (LBW) and neonatal intensive care unit admission was made. Survival of women transplanted <50 years of age with and without pregnancy post-OLT were compared (Dutch Organ Transplantation Registry data). Descriptive statistics, regression analysis, Kaplan Meier and log rank analysis, and generalized estimating equation analysis were used. Among the included 70 women with 113 pregnancies >20 weeks of gestation, hypertension occurred in 20% and preeclampsia in 12%. Live birth rate was 87%; 33% were preterm and 23% had LBW. Long-term follow-up (median 10 years [IQR=4-14]) showed small changes in serum creatinine and bilirubin (p<0.001). Sixteen mothers (23%) died during follow-up (median 8 years [IQR=4-12]), with all their children aged <18 years. No difference in survival was found when comparing women with and without pregnancy post-OLT. The composite outcome occurred in 43/98 of pregnancies. Higher BMI and maternal age at conception increased the composite outcome risk (OR 1.24, p<0.01 and OR 1.25 p=0.01, resp.). To conclude, pregnancy after OLT does not seem to influence long-term outcomes of graft, kidney function nor patient survival in most cases. However, while pregnancy does not seem to impact survival after OLT, we do show that a substantial number of children will lose their mother early in life. We believe this is important for pregnancy counseling of OLT patients and their partners.