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World J Transplant. Nov 28, 2020; 10(11): 320-329
Published online Nov 28, 2020. doi: 10.5500/wjt.v10.i11.320
Obstetrical and gynecologic challenges in the liver transplant patient
Ioannis A Ziogas, Muhammad H Hayat, Georgios Tsoulfas
Ioannis A Ziogas, Medical School, Aristotle University of Thessaloniki, Thessaloniki 54124, Greece
Muhammad H Hayat, Department of Medicine, Division of Gastroenterology, Hepatology and Nutrition, Vanderbilt University Medical Center, Nashville, TN 37212, United States
Georgios Tsoulfas, Department of Surgery, Papageorgiou University Hospital, Aristotle University of Thessaloniki, Thessaloniki 54622, Greece
Author contributions: Ziogas IA, Hayat MH, and Tsoulfas Gconceived and designed the study, acquired, analyzed, and interpreted the data, drafted and critically revised the manuscript, and approved the final version of the manuscript.
Conflict-of-interest statement: The authors have no conflict of interest to report.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Georgios Tsoulfas, MD, PhD, Associate Professor, Department of Surgery, Papageorgiou University Hospital, Aristotle University of Thessaloniki, 66 Tsimski Street, Thessaloniki 54622, Greece. tsoulfasg@gmail.com
Received: July 26, 2020
Peer-review started: July 26, 2020
First decision: September 21, 2020
Revised: October 5, 2020
Accepted: October 20, 2020
Article in press: October 20, 2020
Published online: November 28, 2020
Processing time: 119 Days and 14.7 Hours
Abstract

An increasing number of childbearing agewomen undergo liver transplantation (LT) in the United States. Transplantation in this patient subgroup poses a significant challenge regarding the plans for future fertility, particularly in terms of immunosuppression and optimal timing of conception. Intrapartum LT is only rarely performed as the outcome is commonly dismal for the mother or more commonly the fetus. On the other hand, the outcomes of pregnancy in LT recipients are favorable, and children born to LT recipients are relatively healthy. Counseling on pregnancy should start before LT and continue after LT up until pregnancy, while all pregnant LT recipients must be managed by amultidisciplinary team, including both an obstetrician and a transplant hepatologist. Additionally, an interval of at least 1-2 years after successful LT is recommended before considering pregnancy. Pregnancy-induced hypertension, pre-eclampsia, and gestational diabetes mellitus are reported more commonly during the pregnancies of LT recipients than in the pregnancies of non-transplant patients. As adverse fetal outcomes, such asmiscarriage, abortion, stillbirth, or ectopic pregnancy, may occur more often than in the non-transplant population, early planning or delivery either through a planned induction of labor or cesarean section is critical to minimize the risk of complications. No significant long-term physical or phycological abnormalities have been reported in children born to LT recipients.

Keywords: Liver transplantation; Pregnancy; Obstetric complications; Immunosuppression; Fetal outcomes; End-stage liver disease

Core Tip: An important number of childbearing age women undergo liver transplantation (LT) in the United States. Intrapartum LT is rarely performed as the outcome is commonly dismal for either the mother or the fetus. On the other hand, the outcomes of pregnancy in LT recipients are favorable, and children born to LT recipients are relatively healthy. An interval of at least 1-2 years after successful LT is recommended before considering pregnancy. As adverse fetal outcomes may occur more often than in the non-transplant population, early planning or delivery either through a planned induction of labor or cesarean section is crucial.