ASSOCIATION OF PREGNANCY COMPLICATIONS AND CHOICE OF IMMUNOSUPPRESSANT IN LIVER-TRANSPLANT PATIENTS

Background. The purpose of this study was to identify factors associat ed with antenatal complications for an ongoing series of pregnant wome n who have undergone orthotopic liver transplantation. Methods. We rev iewed Magee-Womens Hospital records from 14 pregnancies in 13 women in whom a liver had been transplanted before pregnancy. We collected and analyzed data regarding the primary liver disease, allograft status, liver function at conception and during pregnancy, immunosuppressive m edications, associated medical conditions, time from transplant to con ception, cytomegalovirus serostatus, and maternal and fetal outcome, R esults. Seven patients had evidence of renal dysfunction (creatinine, 1.3-2.0 mg/dl), five of whom also were hypertensive at their first pre natal visit, The complications of preeclampsia, worsening hypertension , and small for gestational age occurred only in women with renal dysf unction at conception, Renal dysfunction was more often associated wit h cyclosporine than tacrolimus use. Conclusions. Renal dysfunction is the primary determinant of adverse pregnancy outcome in liver transpla nt recipients. Immunosuppression with cyclosporine during pregnancy wa s more often associated with antenatal complications than with the use of tacrolimus.