Pregnancy Outcomes After Liver Transplantation: A Systematic Review

Liver transplantation (LT) constitutes a major therapeutic option for a number of patients suffering from liver pathologies. Pregnancy outcomes in patients who have undergone LT are assessed by a number of studies. The aim of our systematic review was to present the currently available evidence concerning the results of pregnancy in patients with LT. A meticulous systematic search of the literature published before September 2017 for studies relevant in this field was conducted. All studies, which presented obstetric and maternal outcomes of patients with prior LT, were included. Nineteen studies, which comprised 1290 pregnancies in 885 female LT recipients, were reviewed. A total of 1014 live births were recorded, and the incidence of spontaneous abortions ranged from 0.5% to 33.3%. Concerning live births, a proportion of 32% of pregnancies resulted in preterm births (345 preterm births in 1079 pregnancies, range 0%-39%), and in 16% of pregnancies preeclampsia was reported (188 cases from 1173 pregnancies, range 2%-33.3%). The most commonly administered immunosuppressive drugs were cyclosporine and tacrolimus alone or with steroids. Cesarean section rates ranged from 20% to 67.9% among the included studies, concerning live birth. Moreover, approximately one-third of them resulted in preterm birth. Spontaneous abortions were reported in 176 cases (range: 0.5%-33.3%), and preeclampsia occurred in 188 patients (range: 2%-33.3%). Pregnancy outcomes from the included studies are encouraging, nonetheless pregnant patients who have undergone LT are at high risk and therefore require close monitoring by a multidisciplinary team.