National Transplantation Pregnancy Registry: Pregnancy Outcomes in Lung Transplant Recipients.

Abstract

The purpose of this study was to analyze pregnancy outcomes in female lung transplant recipients. Data were collected by the National Transplantation Pregnancy Registry (NTPR) via questionnaires, interviews, and medical records. There were 24 females transplanted between 1991-2010 who reported 33 pregnancies with 35 outcomes (one triplet pregnancy). The mean age at transplant was 28±5.0 yrs (range 19.7-38.5 yrs) and mean transplant-to-conception interval was 3.7±3.2 yrs (range 0.1-11.3 yrs). Conceptions occurred between June 1992 and September 2013. Outcomes included: 19 live births, 11 spontaneous abortions, and 5 therapeutic abortions. Immunosuppression included: cyclosporine (CsA) in 10 and tacrolimus in 23 pregnancies. Comorbid conditions during pregnancy included: hypertension 55%, diabetes 24%, infections 20%, and preeclampsia 5%. Five rejections were reported during pregnancy followed by 3 maternal deaths (9.9 mos, 1.6 yrs, and 4.3 yrs after pregnancy); all of these recipients were on CsA and were transplanted prior to 1996. With a maternal follow-up of 8.1±5.9 yrs, 15 recipients had adequate function (2 re-transplants), 3 had reduced function, 1 had a non-functioning transplant (with reduced native lung function), and 5 had died. Among the 19 newborn, mean gestational age was 33.9±5.0 wks; 63% were preterm (<37 wks). Mean birthweight was 2202±910 g; 63% were low birthweight (<2500 g). Neonatal deaths were reported in association with a triplet pregnancy: one fetus spontaneously aborted at 14 weeks, followed by the death of the two remaining infants delivered at 22 wks. Two children had birth defects: one had atrial and ventricular defects (pacemaker placed to treat arrhythmias) and the other had both hypospadias (repaired at 8 mos) and arteriovenous malformation (corrected when discovered at age 18). At last child follow-up, age 9.3±6.1 yrs, all 17 children were reported otherwise healthy and developing well. Conclusions: Successful pregnancy is possible after lung transplantation. These are high-risk pregnancies with an increased incidence of prematurity and low birthweight infants. Close surveillance of these recipients is warranted due to the potential impact of rejection during pregnancy on graft and recipient survival. All transplant centers are encouraged to participate in the NTPR. DISCLOSURES:Armenti, V.: Grant/Research Support, Novartis, Astellas, Pfizer, BMS.