Pregnancy After Liver Transplantation Is Associated With Increased Risk of Complications

A woman has a higher risk of experiencing a pregnancy-related complication if she has undergone a liver transplant, according to results of a new study presented at the American College of Gastroenterology (ACG) 2019 Annual Scientific Meeting and Postgraduate Course. The findings also suggest pregnant patients have worse patient and hospital outcomes if they have a history of liver transplant.

Recognizing complications during pregnancy among patients who have undergone a liver transplant is important, since the number of liver transplants among women of childbearing age is increasing. Yet research on this topic is limited.

“As more females of childbearing age undergo transplantation and subsequently experience pregnancy, issues regarding complications and the effect on outcomes will only become more relevant,” study coauthor Lindsay Sobotka, DO, a clinical instructor at the Ohio State University Wexner Medical Center, told Gastroenterology Consultant.

Dr Sobotka and colleagues analyzed data on 38,449,030 pregnant women older than 18 years between 2005 and 2013 from the National Inpatient Sample. Among these patients, 1469 had a history of liver transplant.

Multivariable and propensity-weighted analyses were used to evaluate the impact of liver transplant on pregnancy complications and hospital outcomes, which included hospital length of stay and costs.

Women with a history of liver transplant were more likely to have undergone a cesarean delivery and experienced a pregnancy-related complication such as miscarriage, intrauterine growth restriction, postpartum hemorrhage, hypertension during pregnancy, preeclampsia, and venous thromboembolism.

Results of the propensity-weighted analysis indicated that patients who had undergone a liver transplant had a higher rate of pregnancy complications, higher cost of hospital admission, and longer length of hospital stay.

“Liver transplant patients who experience pregnancy-related complications have worse hospital outcomes during admission,” Dr Sobotka said. “It is crucial to recognize factors that worsen patient and hospital outcomes in order to reduce patient morbidity and health care costs.”

Findings from a subset analysis of pregnant patients with a history of liver transplant showed that 56% (n=823) experienced at least one pregnancy-related complication. Those patients also had a longer length of hospital stay and higher cost of hospital admission based on results from the multivariable analysis.

While pregnant patients with a history of liver transplant do not have an increased risk of mortality during pregnancy, Dr Sobotka said, it is still important to recognize pregnancy-related complications.

“Understanding and recognizing these complications can allow for earlier recognition and improved outcomes,” she said. “Further research should be conducted to understand why transplant patients are at an increased risk for these specific pregnancy complications in order to reduce the risk of developing these complications.”

—Melinda Stevens

Reference:

Sobotka L. Pregnancy outcomes after liver transplantation [abstract 13]. Presented at: ACG 2019 Annual Scientific Meeting and Postgraduate Course; October 25-30, 2019; San Antonio, TX.

For more from ACG 2019, visit the Resource Center.