A Single Center Analysis of Graft Vasculopathy Post Pregnancy in the Heart Transplant Recipient

Abstract

Purpose Pregnancy in transplant recipients is becoming more common with improved medication regimens. Pregnancy may increase antibody production and cause stress within the mother's body leading to increase immune system response inducing changes in coronary lumen. This is a single center analysis of transplant graft vasculopathy post pregnancy at our center. No data from the transplant pregnancy registry is available on LHC and vasculopathy data. Per ISHLT report 2017 42% of all heart transplant recipients may experience graft vasculopathy within the first year post transplant. Methods A retrospective study was compiled of all female transplant recipients from 2012-2018 who experienced pregnancy post heart transplant. There were a total of 8 recipients with a total of 12 combined pregnancies. All charts and left heart catherization results post-delivery were reviewed after to one to three months when pre-pregnancy immunosuppression was resumed Results Pre-pregnancy left heart catherization reports in all 8 recipients showed normal coronaries.4 left heart catherization results post pregnancy showed normal coronaries. 2 left heart catherization results showed luminal irregularities. 1 left heart catherization result showed CAV2. One patient did not have a LHC post pregnancy as patient died 6 hours after birth, but left heart catherization results during pregnancy did show luminal irregularities Conclusion Our analysis reflected that 37.5% of patients experienced increased changes in coronary artery lumen post pregnancy (only one confirmed diagnosis of graft vasculopathy (CAV 2) Pregnancy has been shown to influence immune response and B & T cell formation leading to increased chances changes in coronary artery lumen leading to graft vasculopathy. It remains imperative to have a clear and concise plan for pregnancy planning and monitoring pre and post event to prevent luminal changes/graft vasculopathy.