Pregnancy after Lung Transplantation: A Single Center Experience

Abstract

Purpose Advances in lung transplantation have enabled women to successfully undertake pregnancies. We maintain they be at least 2 years post transplant and complication free before pregnancy. This study explores maternal outcomes in pregnancy, including changes in lung and renal function, and calcineurin inhibitor (CNI) levels. Methods and Materials A retrospective audit of lung transplants in Newcastle was undertaken. We identified patients who had ever become pregnant; manual reviews of their medical records were completed. Results of spirometry, serum creatinine, CNI doses and trough levels, and comorbidities were collected. Changes in spirometry were compared using a student t-test; p-values Results There have been 16 pregnancies (complete records available for 12), with 7 live births (44% success rate), amongst 13 patients. Six patients have since died, with one death occurring early post-pregnancy. 5 pregnancies were unplanned, with only one resulting in birth. In all, 5 pregnancies ended with spontaneous miscarriage, while 2 were terminated for medical reasons (one ectopic, one for unstable BOS preconception). Mean age at time of pregnancy was 30.4 years (range 22–39), and mean time from transplant was 35.9 months (range 26–139). Complications included preeclampsia (2, 17%), diabetes of pregnancy (1, 8%), and abnormal liver enzymes (1, 8%). Within six months of delivery, there were 2 pneumonias (17%), 2 cases of BOS (17%), one case of TB (8%) and one case of mild acute rejection (8%). Mean change in FEV1 during full-term pregnancies was -2.4% (range -8.7% to 12.4%, p=0.42) and mean change in FVC was +2.7% (range -1.7% to 11.2%, p=0.55). FEV1 was stable 3 and 12 months after pregnancy (-0.3%, p=0.55 and +2.5%, p=0.69). In the first trimester, 60% had a fall in creatinine and a universal fall in CNI trough levels (mean change -42%) was seen. Conclusions In carefully selected patients, pregnancy after lung transplant can be successful. However, complications are common and close monitoring of immunosuppression levels and renal function are needed.