Background: Pregnancy after solid organ transplant is a significant priority for transplant recipients but how patients report being counseled is unknown.
Methods: We performed a single-center retrospective cohort study and telephone survey of female patients ages 18-49 at the time of kidney, pancreas, or liver transplant from 2000 to 2012 (n = 532). Data on pregnancy counseling, fertility, and maternal, fetal- and transplant-specific outcomes were collected. Multivariate Cox models assessed the impact of pregnancy on graft-specific outcomes.
Results: The survey response rate was 29% (n = 152). One-third (n = 51) of women were actively counseled against pregnancy by one or more providers. A total of 17 pregnancies occurred among nine patients (5.9%), with 47% live births, 47% early embryonic demises, 5.9% stillbirths. Of live births, 50% were premature. Gestational complications, including diabetes, hypertension, and preeclampsia were present in 88% of mothers. Pregnancy after transplant was associated with higher rates of acute rejection than nulliparous transplant recipients (33% vs. 5.6%, p = 0.07) but did not significantly affect graft survival (HR = 1.00, 95% CI 0.99-1.01), after stratifying by organ and adjusting for clinical factors.
Conclusion: This study suggests that transplant patients are being counseled against pregnancy despite acceptable risks of complications and no specific effects on long-term graft function.
Keywords: abdominal organ; acute rejection after pregnancy; fertility in transplant patients; fetal outcomes; graft failure after pregnancy; preconception counseling; pregnancy after transplant; pregnancy outcomes; prenatal counseling; transplant.
© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.