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 K. Mathur

Research output: Contribution to journalArticle

17 Scopus citations

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

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

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