Journal of Liver

Exploring Obstetric Outcomes during Liver Transplantation

Geoffrey Heathcote^* Department of Internal Medicine, Pompeu Fabra University, Barcelona, Spain
^*Correspondence: Geoffrey Heathcote, Department of Internal Medicine, Pompeu Fabra University, Barcelona, Spain, Email:

Received: 01-Nov-2023, Manuscript No. JLR-23-24165; Editor assigned: 03-Nov-2023, Pre QC No. JLR-23-24165(PQ); Reviewed: 23-Nov-2023, QC No. JLR-23-24165; Revised: 01-Dec-2023, Manuscript No. JLR-23-24165(R); Published: 08-Dec-2023, DOI: 10.35248/2167-0889.23.12.208

Description

Nutritional Liver transplantation is a life-saving procedure that can restore the quality of life and fertility of women with endstage liver disease. However, pregnancy after liver transplantation poses several challenges and risks for both the mother and the fetus. Therefore, it is important to evaluate the obstetric outcomes and the optimal management of these pregnancies. Pregnancy after liver transplantation is considered a high-risk pregnancy, as it is associated with increased rates of maternal and fetal complications, such as preeclampsia, preterm delivery, low birth weight, intrauterine growth restriction, and congenital anomalies. Moreover, pregnancy may affect the graft function and the immunosuppressive therapy, which may increase the risk of rejection, infection, and adverse drug effects [1]. The literature on pregnancy after liver transplantation is limited by the small number of cases, the heterogeneity of the study populations, the lack of standardized protocols, and the long-term follow-up. However, some studies have compared the obstetric outcomes of liver transplant recipients with those of other solid organ transplant recipients, such as kidney and cardiothoracic transplant recipients [2]. They reported and evaluated the pregnancy outcomes of 14 pregnancies in 10 women who had undergone liver transplantation at a single transplant center. The study found that pregnancy after liver transplantation can achieve relatively favorable outcomes, with low rates of minor graft complications and no cases of graft loss or maternal mortality. The study also found that liver transplantation did not influence women’s fertility, as the mean transplant-topregnancy interval was 4.07 years and two pregnancies were unintended [3,4]. However, the study also reported high rates of preterm delivery (41.67%) and cesarean delivery (58.33%), which may be related to the maternal and fetal conditions, the immunosuppressive regimen, and the obstetric management.

The pregnancy outcomes of liver and cardiothoracic transplant recipients using data from the National Transplantation Pregnancy Registry, a voluntary registry that collects information on pregnancies in female solid organ transplant recipients and their offspring [5-8]. The study included 253 pregnancies in 154 liver transplant recipients and 77 pregnancies in 53 cardiothoracic transplant recipients. The study found that liver transplant recipients, in comparison to cardiothoracic, had similar livebirth rates (92% vs. 87%) but better fetal outcomes (median gestational age 38 weeks vs. 35 weeks; median birthweight 2698 g vs. 2365 g), fewer caesarean deliveries (47% vs. 62%), fewer Maternal Intensive Care (ICU) admissions (19% vs. 29%) and fewer neonatal ICU admissions (25% vs. 54%). The study also found that the type of immunosuppression did not affect the pregnancy outcomes, except for the use of mycophenolate mofetil, which was associated with an increased risk of fetal malformations and pregnancy loss. The results of these studies suggest that pregnancy after liver transplantation is feasible and safe, but requires careful preconception counseling, close monitoring, and multidisciplinary care [9,10]. The optimal timing of pregnancy after liver transplantation is not well established, but some experts recommend waiting at least one year after transplantation, when the graft function is stable and the immunosuppressive dose is low.

Conclusion

As immunosuppressive agents are individualized, based on the risk-benefit ratio for the mother and the fetus, and avoiding teratogenic drugs such as mycophenolate mofetil. The mode of delivery should be decided according to the obstetric indications, the maternal and fetal conditions, and the graft status. The postpartum period should include regular assessment of the graft function, the immunosuppressive levels, and the maternal and neonatal well-being. However, with proper planning, management, and follow-up, pregnancy after liver transplantation can result in satisfactory obstetric outcomes and a positive impact on the quality of life of the mother and the child.

References

1. Christakos S, Dhawan P, Verstuyf A, Verlinden L, Carmeliet G. Vitamin D: Metabolism, Molecular Mechanism of Action, and Pleiotropic Effects. Physiol Rev. 2016; 96 (1): 365-408.

   [Crossref] [Google Scholar] [PubMed]

2. Costa PL, França MM, Katayama ML, Carneiro ET, Martin RM, Folgueira MA, et al. Transcriptomic Response to 1,25-Dihydroxyvitamin D in Human Fibroblasts with or without a Functional Vitamin D Receptor (VDR): Novel Target Genes and Insights into VDR Basal Transcriptional Activity. Cells. 2019; 8 (4):318.

   [Crossref] [Google Scholar] [PubMed]

3. Haider N, Hasan MN, Khan RA. The Global case-fatality rate of COVID-19 has been declining disproportionately between top vaccinated countries and the rest of the world. IJID Regions. 2023;6:159-166.

   [Crossref] [Google Scholar] [PubMed]

4. Girma D, Dejene H, Adugna L. COVID-19 case fatality rate and factors contributing to mortality in Ethiopia: A systematic review of current evidence. Infect Drug Resist. 2022;15:3491-3501.

   [Crossref] [Google Scholar] [PubMed]

5. Martínez-Baz, Miqueleiz A, Working Group for the Study of COVID-19 in Navarra. Effectiveness of COVID-19 vaccines in preventing SARS-CoV-2 infection and hospitalisation, Navarre, Spain, January to April 2021. Euro surveill. 2021;26(21):2100438.

   [Crossref] [Google Scholar] [PubMed]

6. Abu-Raddad LJ, Chemaitelly H, National Study Group for COVID-19 Vaccination. Waning mRNA-1273 vaccine effectiveness against SARS-CoV-2 infection in Qatar. N Engl J Med. 2022;386(11):1091-1093.

   [Crossref] [Google Scholar] [PubMed]

7. Stowe J, Andrews N, Kirsebom F. Effectiveness of COVID-19 vaccines against Omicron and Delta hospitalisation: Test negative case-control study. MedRxiv. 2022; 30;13(1):5736.

   [Crossref] [Google Scholar] [PubMed]

8. Hitchings MDT, Ranzani OT, Dorion M. Effectiveness of ChAdOx1 vaccine in older adults during SARS-CoV-2 Gamma variant circulation in São Paulo. Nat Commun. 2021;12(1):6220.

   [Crossref] [Google Scholar] [PubMed]

9. Sritipsukho P, Khawcharoenporn T, Siribumrungwong B. Comparing real-life effectiveness of various COVID-19 vaccine regimens during the delta variant-dominant pandemic: A test-negative case-control study. Emerg Microbes Infect. 2022;11(1):585-592.

   [Crossref] [Google Scholar] [PubMed]

10. Oran DP, Topol EJ. Prevalence of asymptomatic SARS-CoV-2 infection: A narrative review. Ann Intern Med. 2020;173(5):362-367.

    [Crossref] [Google Scholar] [PubMed]