Pregnancy Outcomes in 53 Female Lung Transplant Recipients.
Publication/Presentation Date
5-9-2025
Abstract
BACKGROUND: Limited data exists to inform and appropriately counsel female lung transplant (LuT) recipients regarding post-transplant pregnancy.
QUESTION: What are the modifiable factors that impact pregnancy outcomes in female LuT recipients?
STUDY DESIGN AND METHODS: Retrospective observational analysis was performed on female LuT recipients who reported post-transplant pregnancies to the Transplant Pregnancy Registry International (TPRI).
RESULTS: Fifty-three recipients transplanted from 1991-2021 reported 72 pregnancies to TPRI. Predominant indications for transplant were cystic fibrosis (60%) and pulmonary hypertension (19%). Contraceptive use post-transplant was 36%. The majority of recipients (54%) had unplanned pregnancies. The livebirth rate was 62% resulting in 46 livebirths. Approximately 60% were premature (< 37 weeks gestational age, GA) and low birth weight (LBW, < 2500 grams). Birth defects were seen in 7 (16%) children; none with mycophenolic acid (MPA) embryopathy. Three neonatal deaths resulted from extreme prematurity; 43 remaining children are healthy. Twenty recipients (38%) have died a median of 23.6 years post-LuT. Recipients with transplant-to-conception interval ≤2 years had no difference in mortality compared to >2 years (HR 1.26 95% CI 0.50-3.12, p=0.625). Recipients whose first pregnancy post-transplant was unplanned had lower survival (HR 7.02, 95% CI 1.35-36.45, p=0.020). Newborns of LuT recipients with planned compared to unplanned pregnancies have higher median GA (36.9 versus 34 weeks, p=0.025) and birthweight (2639 versus 2155 grams, p=0.047), and significantly lower risk of LBW for singletons (OR 0.26, 95% CI 0.07-0.94, p=0.036).
INTERPRETATION: Successful pregnancy after lung transplantation is achievable, however not without risks for mother and offspring. Planned pregnancies resulted in higher GA and birth weight liveborn and had lower post-pregnancy mortality. TPRI data show 54% of recipients reported unplanned pregnancies, an obvious area for improvement. Planning pregnancy is the most modifiable factor for mitigating risks.
ISSN
1931-3543
Published In/Presented At
Lee, F. G., Coscia, L. A., Constantinescu, S., & Moritz, M. J. (2025). Pregnancy Outcomes in 53 Female Lung Transplant Recipients. Chest, S0012-3692(25)00574-4. Advance online publication. https://doi.org/10.1016/j.chest.2025.05.005
Disciplines
Medicine and Health Sciences
PubMedID
40350146
Department(s)
Department of Surgery
Document Type
Article