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Pregnancy after lung and heart-lung transplantation

Lookup NU author(s): Dr James Lordan, Dr Gerard Meachery, Professor Andrew Fisher, Dr Gareth Parry

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Abstract

BACKGROUND: Advances in lung transplantation have enabled women to successfully undertake pregnancies. This study explored outcomes in this group, including changes in lung function, kidney function, and calcineurin inhibitor (CNI) levels.METHODS: A retrospective review identified 19 transplant recipients who had ever become pregnant at our center, and manual reviews of their medical records were completed for 14. Results of spirometry, serum creatinine, CNI doses and trough levels, and comorbidities were collected.RESULTS: Eight births occurred (42% success rate). Six patients have since died, with pregnancy contributing to 1 death. Five pregnancies were unplanned, with only 1 resulting in birth. Six pregnancies ended with spontaneous termination, and 2 were terminated for medical reasons. Mean age was 31.4 years (range, 22-39 years), and mean time from transplant was 76.2 months (range, 26-139 months). Complications included preeclampsia in 2, diabetes of pregnancy in 1, and abnormal liver enzymes in 1. Within 6 months of delivery, there were 2 cases of pneumonia, 2 cases of obliterative bronchiolitis, 1 case of tuberculosis, and 1 case of mild acute rejection. Forced expiratory volume in 1 second was stable at 3 (-1.5%; p = 0.55) and 12 months (1.4%; p = 0.84) after pregnancy. Mean change in Forced expiratory volume in 1 second during full-term pregnancies was -2.4% (p = 0.29), and the mean change in forced vital capacity was -0.8% (p = 0.55). In the first trimester, 83% of patients had a fall in creatinine, and a universal fall in CM trough levels was seen.CONCLUSIONS: In carefully selected patients, planned pregnancy after lung transplant can be successful. Complications are common, and close monitoring of immunosuppression and renal function is needed. I Heart Lung Transplant 2014;33:593-598 (C) 2014 International Society for Heart and Lung Transplantation. All rights reserved.


Publication metadata

Author(s): Thakrar MV, Morley K, Lordan JL, Meachery G, Fisher AJ, Parry G, Corns PA

Publication type: Article

Publication status: Published

Journal: Journal of Heart and Lung Transplantation

Year: 2014

Volume: 33

Issue: 6

Pages: 593-598

Print publication date: 17/02/2014

ISSN (print): 1053-2498

ISSN (electronic): 1557-3117

Publisher: Elsevier Ireland Ltd.

URL: http://dx.doi.org/10.1016/j.healun.2014.02.008

DOI: 10.1016/j.healun.2014.02.008


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