Preconception counseling, fertility, and pregnancy complications after abdominal organ transplantation: A survey and cohort study of 532 recipients

Devon M. Rupley, Allison M. Janda, Steven R. Kapeles, Tim M. Wilson, Deborah Berman, Amit Mathur

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)937-945
Number of pages9
JournalClinical Transplantation
Volume28
Issue number9
DOIs
StatePublished - 2014

Fingerprint

Pregnancy Complications
Organ Transplantation
Fertility
Counseling
Cohort Studies
Transplants
Pregnancy
Live Birth
Mothers
Stillbirth
Graft Survival
Diabetes Complications
Pre-Eclampsia
Surveys and Questionnaires
Proportional Hazards Models
Telephone
Pancreas
Retrospective Studies
Hypertension
Kidney

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

ASJC Scopus subject areas

  • Transplantation
  • Medicine(all)

Cite this

Preconception counseling, fertility, and pregnancy complications after abdominal organ transplantation : A survey and cohort study of 532 recipients. / Rupley, Devon M.; Janda, Allison M.; Kapeles, Steven R.; Wilson, Tim M.; Berman, Deborah; Mathur, Amit.

In: Clinical Transplantation, Vol. 28, No. 9, 2014, p. 937-945.

Research output: Contribution to journalArticle

Rupley, Devon M. ; Janda, Allison M. ; Kapeles, Steven R. ; Wilson, Tim M. ; Berman, Deborah ; Mathur, Amit. / Preconception counseling, fertility, and pregnancy complications after abdominal organ transplantation : A survey and cohort study of 532 recipients. In: Clinical Transplantation. 2014 ; Vol. 28, No. 9. pp. 937-945.
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abstract = "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.",
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AB - 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.

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