REPRODUCTIVE FUNCTION AND OUTCOME OF PREGNANCY AFTER LIVER-TRANSPLANTATION IN WOMEN

Objective: To discuss menstrual function before and after liver transp lantation, immunosuppression. during pregnancy, outcome and management of pregnancy, and use of contraception in women after liver transplan tation. Material and Methods: We review the relevant medical literatur e and describe our clinical experience in the management of gynecologi c and obstetric issues in recipients of liver transplants. Results: Me nstrual abnormalities, such as amenorrhea, oligomenorrhea, irregular b leeding, and metrorrhagia, are common in women with liver disease and may often be the first clinical indication of liver dysfunction, Norma l menstrual function is frequently restored after transplantation. Suc cessful pregnancies have occurred in recipients of liver transplants, but such pregnancies are often complicated by preterm delivery, preecl ampsia, and infection, Use of immunosuppressive medications should be maintained during pregnancy, and drug concentrations should be careful ly monitored; none has been found to be teratogenic, Pregnancy does no t seem to accelerate graft rejection, Barrier contraception or sterili zation, if appropriate, seems to be the safest option for these patien ts. Conclusion: Because liver transplantation leads to restoration of normal menstruation, female patients of reproductive age must be couns eled about the possibility of pregnancy and the use of contraception, Pregnancy should be avoided for at least the first 6 months after tran splantation. With specialized care and attention, pregnancies are gene rally associated with good outcomes.