58 Sorting Out the Intricacies of Multiparity Risk on Outcomes after Heart Transplantation

Abstract

<h3>Purpose</h3> It has been demonstrated in the ISHLT registry that parous females have increased risk of rejection in the first year after heart transplant (HTx) vs. nulliparous females (JHLT 1997; 16(8):801-12). It has not been established whether the number of pregnancies incrementally increases this risk in patients (pts) on triple drug immunosuppression. Therefore we reviewed our female HTx pts for the number of pregnancies and 1st-year rejection after HTx. <h3>Methods and Materials</h3> We reviewed 280 female pts transplanted between 1994 and 2009 for number of pregnancies. Pts were divided according to number of pregnancies, from 0 to ≥5. These groups were assessed for the development of circulating antibodies (Ab) prior to transplant. Post HTx, we assessed 1st-year freedom from any-treated rejection and 5-year actuarial survival, freedom from cardiac allograft vasculopathy (CAV, any stenosis > 30%), and non-fatal major adverse cardiac events (NF-MACE: myocardial infarction, heart failure, stents, defibrillator, stroke, and new peripheral vascular disease). <h3>Results</h3> Post Htx, pts in the 4 or ≥5 pregnancy groups had increased risk for antibody mediated rejection (AMR) and any-treated rejection compared to those pts with 0-3 pregnancies (p<0.05). Pts with 0, 1, 2 and 3 pregnancies were found to have similar 1st-year freedom from any-treated rejection, including cellular rejection and AMR. There was no significant difference in 5-year actuarial survival, freedom from CAV, and freedom from NF-MACE between all groups. The percent of pts with positive pre-transplant circulating Ab (PRA > 10%) was comparable between the 4-5 pregnancy groups and the 0-3 pregnancy groups (15% vs. 16%, p=0.97) <h3>Conclusions</h3> Multiparity with ≥4 pregnancies appears to hold the greatest risk for AMR in the 1st year after HTx. We speculate that this may be due to increased memory B cells as pre-transplant sensitization was similar in all multiparous groups. Parous female pts with 1 to 3 pregnancies may not be at increased rejection risk compared to nulliparous female heart recipients.