دورية أكاديمية
Pregnancy outcomes following single and repeat liver transplantation: An international 2-center cohort.
| العنوان: | Pregnancy outcomes following single and repeat liver transplantation: An international 2-center cohort. |
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| المؤلفون: | Zaffar N; Division of Maternal and Fetal Medicine, Department of Obstetrics & Gynaecology, Mount Sinai Hospital, University of Toronto, Canada., Soete E; Department of Obstetrics and Gynecology, University Hospital Leuven, Leuven, Belgium., Gandhi S; Division of Obstetric Medicine, Department of Internal Medicine, Mount Sinai Hospital, University of Toronto, Canada., Sayyar P; Division of Maternal and Fetal Medicine, Department of Obstetrics & Gynaecology, Mount Sinai Hospital, University of Toronto, Canada., Van Mieghem T; Division of Maternal and Fetal Medicine, Department of Obstetrics & Gynaecology, Mount Sinai Hospital, University of Toronto, Canada.; Department of Obstetrics and Gynecology, University Hospital Leuven, Leuven, Belgium., D'Souza R; Division of Maternal and Fetal Medicine, Department of Obstetrics & Gynaecology, Mount Sinai Hospital, University of Toronto, Canada. |
| المصدر: | Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society [Liver Transpl] 2018 Jun; Vol. 24 (6), pp. 769-778. |
| نوع المنشور: | Comparative Study; Journal Article; Multicenter Study |
| اللغة: | English |
| بيانات الدورية: | Publisher: Wolters Kluwer Health, Inc Country of Publication: United States NLM ID: 100909185 Publication Model: Print Cited Medium: Internet ISSN: 1527-6473 (Electronic) Linking ISSN: 15276465 NLM ISO Abbreviation: Liver Transpl Subsets: MEDLINE |
| أسماء مطبوعة: | Publication: 2023- : [Philadelphia] : Wolters Kluwer Health, Inc. Original Publication: Philadelphia, PA : W.B. Saunders Co., c2000- |
| مواضيع طبية MeSH: | Pregnancy Outcome*, End Stage Liver Disease/*surgery , Graft Rejection/*surgery , Liver Transplantation/*adverse effects , Pregnancy Complications/*epidemiology, Adult ; Belgium ; Canada ; Female ; Gestational Age ; Graft Rejection/epidemiology ; Graft Rejection/prevention & control ; Humans ; Immunosuppressive Agents/therapeutic use ; Incidence ; Infant, Newborn ; Infant, Small for Gestational Age ; Liver Transplantation/statistics & numerical data ; Maternal Age ; Medication Adherence ; Pregnancy ; Reoperation/adverse effects ; Reoperation/statistics & numerical data ; Retrospective Studies ; Tertiary Care Centers/statistics & numerical data ; Treatment Outcome ; Young Adult |
| مستخلص: | Due to advances in obstetric and transplant medicine, women with a history of liver transplantation can have successful pregnancies. However, data on pregnancy outcomes is still limited, especially for women who have had a repeat liver transplant following graft rejection. This retrospective study compares pregnancy outcomes in women with single and repeat liver transplants managed at 2 tertiary hospitals in Toronto, Canada and Leuven, Belgium. We identified 41 pregnancies in 28 transplanted women, 6 of whom conceived following a second liver transplant after the first was rejected. Mean maternal age at delivery was 30 ± 7 years, and transplant-to-pregnancy interval was 8.5 ± 5.1 years. All women had normal liver function upon conception. Immunosuppressants included tacrolimus ± azathioprine (n = 26), cyclosporine (n = 4), and prednisone with immunosuppressants (n = 11). There were no maternal deaths. Maternal complications included hypertensive disorders of pregnancy (n = 10), deterioration in renal function (n = 6), gestational diabetes (n = 4), graft deterioration (n = 2), and anemia requiring blood transfusion (n = 1). Fetal/neonatal adverse outcomes included 2 miscarriages, 3 stillbirths, 1 neonatal death, 5 small-for-gestational-age infants, and 1 minor congenital anomaly. Mean gestational age at delivery was 36.7 ± 4.2 weeks. There were 14 (38.9%) preterm births. Outcomes in women with a second transplant were similar to those with a single transplant, except for a higher incidence of hypertensive disorders. In conclusion, with appropriate multidisciplinary care, stable graft function at pregnancy onset, and adherence to immunosuppressive regimens, women with single and repeat liver transplants have low rates of graft complications but remain at increased risk for pregnancy complications. Immunosuppressants and high-dose glucocorticoids can be safely used for maintenance of graft function and management of graft deterioration in pregnancy. Liver Transplantation 24 769-778 2018 AASLD. (© 2018 by the American Association for the Study of Liver Diseases.) |
| المشرفين على المادة: | 0 (Immunosuppressive Agents) |
| تواريخ الأحداث: | Date Created: 20180415 Date Completed: 20190218 Latest Revision: 20190219 |
| رمز التحديث: | 20221213 |
| DOI: | 10.1002/lt.25071 |
| PMID: | 29655314 |
| قاعدة البيانات: | MEDLINE |
Full Text Finder | تدمد: | 1527-6473 |
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| DOI: | 10.1002/lt.25071 |