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09 June 2020 : Original article  

Pregnancy Outcomes Following Pediatric Liver Transplantation: A Single-Center Experience in Japan

Itsuki Naya1ABCDEF*, Yukihiro Sanada1ABCDEF, Takumi Katano1BCD, Go Miyahara1BCD, Yuta Hirata1BCD, Naoya Yamada1BCD, Noriki Okada1BCD, Yasuharu Onishi1DEF, Yasunaru Sakuma1DEF, Naohiro Sata1DEF

DOI: 10.12659/AOT.921193

Ann Transplant 2020; 25:e921193

Abstract

BACKGROUND: The number of pregnancies after liver transplantation (LT) is increasing; however, the safety and incidence of complications associated with these pregnancies are still unclear. In this report, we retrospectively assessed the influences and problems associated with post-transplant pregnancy on allografts, recipients, and fetuses.

MATERIAL AND METHODS: A total of 14 pregnancies were identified in 8 female recipients between 2005 and 2018. The original disease was biliary atresia in all recipients. We provide a basic guide for the management of planned pregnancies in female recipients.

RESULTS: Of the 7 planned pregnancies, no recipients took mycophenolate mofetil (MMF) or had allograft liver dysfunction. Among the 7 unplanned conceptions, we judged that the pregnancy was inadequate to continue in 4 recipients due to taking MMF and 2 recipients due to allograft liver dysfunction at conception. However, 4 recipients who immediately stopped taking MMF continued with their pregnancies. Ten pregnancies resulted in live 11 births. Among obstetric complications or fetal and neonatal complications, gestational diabetes mellitus in 3 recipients was the most common. There were 3 miscarriages and 1 planned termination because of MMF medication and liver dysfunction.

CONCLUSIONS: Planned pregnancies in LT recipients can lead to the birth of a healthy baby and no influence on either the allograft or the recipient. However, unplanned pregnancies in LT recipients, such as recipients who take MMF or have allograft liver dysfunction, may have an adverse influence on the fetus.

Keywords: Immunosuppression, Liver Transplantation, Pregnancy, Unplanned, Adolescent, biliary atresia, Immunosuppressive Agents, Japan, Prednisolone, Pregnancy, Pregnancy Outcome, Tacrolimus, young adult

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Annals of Transplantation eISSN: 2329-0358
Annals of Transplantation eISSN: 2329-0358