Maternal hemodynamics and pregnancy outcome in women with prior orthotopicliver transplantation

The aim of this study is to evaluate the hemodynamics and pregnancy outcome of women with prior orthotopic liver transplantation. Hemodynamic measurem ents by Doppler technique were performed on pregnant subjects with prior or thotopic liver transplantation. Maternal characteristics, renal function, p regnancy complications, delivery indications, delivery mode, and neonatal o utcomes were evaluated. Six pregnancies occurred in 5 women after orthotopi c liver transplantation at the University of Washington Medical Center (Sea ttle, WA) between 1991 and 1999, Four of the 6 pregnancies were complicated by chronic hypertension, fetal growth restriction, and preterm delivery. T wo pregnancies had worsening hypertension characterized by vasoconstriction in the second trimester despite antihypertensive therapy. These 2 subjects were administered cyclosporine for maintenance immunosuppression and had g reater mean arterial pressures preconception and in the first trimester tha n the other subjects. One of these pregnancies resulted in fetal demise at 25 weeks' gestation. The other subject was delivered at 28 weeks' gestation for nonreassuring fetal status and superimposed preeclampsia, All pregnanc ies were complicated by renal insufficiency; however, the 2 subjects with p oor obstetric outcome had preconception serum creatinine levels greater tha n 1.5 mg/dL and creatinine clearances less than 40 mL/min, pregnancies comp licated by second-trimester vasoconstriction and moderate renal insufficien cy are at risk for preeclamspia, fetal growth restriction, and fetal demise , Good obstetric outcome can occur in women with mild renal insufficiency a nd well-controlled chronic hypertension. Improved hypertensive control prec onception may decrease the risk for preeclampsia and poor obstetric outcome . Copyright (C) 2000 by the American Association for the Study of Liver Dis eases.