{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,18]],"date-time":"2026-10-18T03:27:26Z","timestamp":1792294046548,"version":"4.4.0"},"reference-count":34,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"5","license":[{"start":{"date-parts":[[2018,4,10]],"date-time":"2018-04-10T00:00:00Z","timestamp":1523318400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"},{"start":{"date-parts":[[2018,4,10]],"date-time":"2018-04-10T00:00:00Z","timestamp":1523318400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Liver Transpl"],"published-print":{"date-parts":[[2018,5]]},"abstract":"<jats:p>Liver transplantation (LT) is a successful treatment for both acute liver failure and end\u2010stage liver disease. The number of women of reproductive age undergoing LT is increasing. Pregnancy outcomes are favorable, but there is still a lack of prognostic markers. We aimed to identify factors predictive of adverse pregnancy outcomes in LT recipients. An analysis of all pregnancies occurring in LT recipients from 1989 to 2016 at King's College Hospital was performed. Clinical data of 162 conceptions in 93 women were reviewed. Descriptive and regression analyses were done to examine associations between laboratory markers and hepatological scores with pregnancy outcomes of live birth and preterm birth. Median age at LT was 23 years (range, 1\u201041 years), with a median age at conception of 30 years (range, 18\u201047 years). The live birth rate was 75% (n = 121). Of live births, 35% (n = 39\/110 available) were delivered preterm. Preconception creatinine levels were higher in patients who had a preterm birth (85 versus 74 \u03bcmol\/L; <jats:italic toggle=\"yes\">P<\/jats:italic> = 0.008), with a preconception estimated glomerular filtration rate (eGFR) &lt;90 mL\/minute significantly associated with preterm delivery (<jats:italic toggle=\"yes\">P<\/jats:italic> = 0.04). Progressive decline in eGFR predicted outcome, with gestational length declining with increasing chronic kidney disease (CKD) stage: CKD 0\u20101 = 39 weeks (median), CKD 2 = 37 weeks, and CKD 3 = 35 weeks. The risk of preterm birth was greatest in women with an eGFR &lt;60 mL\/minute (<jats:italic toggle=\"yes\">P<\/jats:italic> = 0.004). Moreover, hypertension\u2010related complications during pregnancy, such as gestational hypertension, preeclampsia, or eclampsia, were also associated with prematurity (<jats:italic toggle=\"yes\">P<\/jats:italic> = 0.01). Women taking steroid\u2010based immunosuppression had an increased risk of infection during pregnancy or postpartum (15% versus 4%; <jats:italic toggle=\"yes\">P<\/jats:italic> = 0.02). In conclusion, although the majority of women have a successful pregnancy outcome after LT, preconception renal function predicts pregnancy outcome and steroids increase risk of infection during pregnancy or postpartum. <jats:italic toggle=\"yes\">Liver Transplantation 24 606\u2013615 2018<\/jats:italic> AASLD.<\/jats:p>","DOI":"10.1002\/lt.25034","type":"journal-article","created":{"date-parts":[[2018,3,15]],"date-time":"2018-03-15T12:00:48Z","timestamp":1521115248000},"page":"606-615","source":"Crossref","is-referenced-by-count":34,"title":["Successful pregnancy outcomes following liver transplantation is predicted by renal function"],"prefix":"10.1097","volume":"24","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4814-5754","authenticated-orcid":false,"given":"Tiong Y.","family":"Lim","sequence":"first","affiliation":[{"name":"Institute of Liver Studies,King's College Hospital,London,United Kingdom"},{"name":"King's Liver Pregnancy Research Group,King's College Hospital,London,United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Enoka","family":"Gonsalkorala","sequence":"additional","affiliation":[{"name":"Institute of Liver Studies,King's College Hospital,London,United Kingdom"},{"name":"King's Liver Pregnancy Research Group,King's College Hospital,London,United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mary D.","family":"Cannon","sequence":"additional","affiliation":[{"name":"Institute of Liver Studies,King's College Hospital,London,United Kingdom"},{"name":"King's Liver Pregnancy Research Group,King's College Hospital,London,United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stella","family":"Gabeta","sequence":"additional","affiliation":[{"name":"Institute of Liver Studies,King's College Hospital,London,United Kingdom"},{"name":"King's Liver Pregnancy Research Group,King's College Hospital,London,United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leonie","family":"Penna","sequence":"additional","affiliation":[{"name":"Department of Obstetrics,King's College Hospital,London,United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nigel D.","family":"Heaton","sequence":"additional","affiliation":[{"name":"Institute of Liver Studies,King's College Hospital,London,United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael A.","family":"Heneghan","sequence":"additional","affiliation":[{"name":"Institute of Liver Studies,King's College Hospital,London,United Kingdom"},{"name":"King's Liver Pregnancy Research Group,King's College Hospital,London,United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2018,4,10]]},"reference":[{"key":"lt25034-bib-0001-20240115","doi-asserted-by":"crossref","first-page":"340","DOI":"10.1016\/0002-9378(78)90906-7","article-title":"Successful pregnancy in a liver transplant patient","volume":"132","year":"1978","journal-title":"Am J Obstet Gynecol"},{"issue":"part 2","key":"lt25034-bib-0002-20240115","first-page":"2197","article-title":"Liver transplantation: an unfinished product","volume":"21","year":"1989","journal-title":"Transplant Proc"},{"key":"lt25034-bib-0003-20240115","doi-asserted-by":"crossref","first-page":"1606","DOI":"10.1136\/gut.2006.111369","article-title":"Survival after liver transplantation in the United Kingdom and Ireland compared with the United States","volume":"56","year":"2007","journal-title":"Gut"},{"key":"lt25034-bib-0004-20240115","doi-asserted-by":"crossref","first-page":"2384","DOI":"10.1111\/ajt.12384","article-title":"Twenty\u2010year longitudinal follow\u2010up after orthotopic liver transplantation: a single\u2010center experience of 313 consecutive cases","volume":"13","year":"2013","journal-title":"Am J Transplant"},{"key":"lt25034-bib-0007-20240115","doi-asserted-by":"crossref","first-page":"337","DOI":"10.1136\/gut.31.3.337","article-title":"Recovery of menstruation and pregnancy after liver transplantation","volume":"31","year":"1990","journal-title":"Gut"},{"key":"lt25034-bib-0008-20240115","doi-asserted-by":"crossref","first-page":"202","DOI":"10.1136\/gut.32.2.202","article-title":"Amenorrhoea in women with non\u2010alcoholic chronic liver disease","volume":"32","year":"1991","journal-title":"Gut"},{"key":"lt25034-bib-0009-20240115","doi-asserted-by":"crossref","first-page":"507","DOI":"10.1016\/j.jhep.2008.07.011","article-title":"Pregnancy and sexual function in liver transplantation","volume":"49","year":"2008","journal-title":"J Hepatol"},{"key":"lt25034-bib-0010-20240115","first-page":"103","article-title":"Report from the National Transplantation Pregnancy Registry (NTPR): outcomes of pregnancy after transplantation","year":"2009","journal-title":"Clin Transpl"},{"key":"lt25034-bib-0011-20240115","doi-asserted-by":"crossref","first-page":"621","DOI":"10.1002\/lt.23416","article-title":"Pregnancy outcomes of liver transplant recipients: a systematic review and meta\u2010analysis","volume":"18","year":"2012","journal-title":"Liver Transpl"},{"key":"lt25034-bib-0012-20240115","doi-asserted-by":"crossref","first-page":"1391","DOI":"10.1002\/lt.24514","article-title":"Favorable longterm outcomes of liver transplant recipients treated de novo with once\u2010daily tacrolimus: results of a single\u2010center cohort","volume":"22","year":"2016","journal-title":"Liver Transpl"},{"key":"lt25034-bib-0013-20240115","doi-asserted-by":"crossref","first-page":"1476","DOI":"10.1111\/jog.13096","article-title":"Pregnancy outcomes in liver transplant recipients: A 15\u2010year single\u2010center experience","volume":"42","year":"2016","journal-title":"J Obst Gynaecol Res"},{"key":"lt25034-bib-0014-20240115","doi-asserted-by":"crossref","first-page":"1408","DOI":"10.1002\/lt.24483","article-title":"Pregnancy in the liver transplant recipient","volume":"22","year":"2016","journal-title":"Liver Transpl"},{"key":"lt25034-bib-0015-20240115","doi-asserted-by":"crossref","first-page":"469","DOI":"10.1097\/TP.0b013e318225db4d","article-title":"Elective liver transplant list mortality: development of a United Kingdom End\u2010Stage Liver Disease score","volume":"92","year":"2011","journal-title":"Transplantation"},{"key":"lt25034-bib-0016-20240115","doi-asserted-by":"crossref","first-page":"1652","DOI":"10.1053\/j.gastro.2006.02.010","article-title":"Evidence\u2010based incorporation of serum sodium concentration into MELD","volume":"130","year":"2006","journal-title":"Gastroenterology"},{"key":"lt25034-bib-0017-20240115","doi-asserted-by":"crossref","first-page":"550","DOI":"10.1200\/JCO.2014.57.9151","article-title":"Assessment of liver function in patients with hepatocellular carcinoma: a new evidence\u2010based approach\u2014the ALBI grade","volume":"33","year":"2015","journal-title":"J Clin Oncol"},{"key":"lt25034-bib-0018-20240115","doi-asserted-by":"crossref","first-page":"494","DOI":"10.1016\/S0168-8278(01)00309-9","article-title":"MELD score is better than Child\u2010Pugh score in predicting 3\u2010month survival of patients undergoing transjugular intrahepatic portosystemic shunt","volume":"36","year":"2002","journal-title":"J Hepatol"},{"key":"lt25034-bib-0019-20240115","doi-asserted-by":"crossref","first-page":"518","DOI":"10.1053\/jhep.2003.50346","article-title":"A simple noninvasive index can predict both significant fibrosis and cirrhosis in patients with chronic hepatitis C","volume":"38","year":"2003","journal-title":"Hepatology"},{"key":"lt25034-bib-0020-20240115","doi-asserted-by":"crossref","first-page":"604","DOI":"10.7326\/0003-4819-150-9-200905050-00006","article-title":"A new equation to estimate glomerular filtration rate","volume":"150","year":"2009","journal-title":"Ann Intern Med"},{"key":"lt25034-bib-0021-20240115","doi-asserted-by":"crossref","first-page":"137","DOI":"10.7326\/0003-4819-139-2-200307150-00013","article-title":"National kidney foundation practice guidelines for chronic kidney disease: evaluation, classification, and stratification","volume":"139","year":"2003","journal-title":"Ann Intern Med"},{"key":"lt25034-bib-0022-20240115","doi-asserted-by":"crossref","first-page":"588","DOI":"10.1002\/ajmg.a.35223","article-title":"Teratogenicity of mycophenolate confirmed in a prospective study of the European Network of Teratology Information Services","volume":"158A","year":"2012","journal-title":"Am J Med Genet A"},{"key":"lt25034-bib-0023-20240115","doi-asserted-by":"crossref","first-page":"875","DOI":"10.1111\/j.1471-0528.2005.00565.x","article-title":"Outcomes of severe pre\u2010eclampsia\/eclampsia in Yorkshire 1999\/2003","volume":"112","year":"2005","journal-title":"BJOG"},{"key":"lt25034-bib-0024-20240115","doi-asserted-by":"crossref","first-page":"1966","DOI":"10.1016\/j.transproceed.2013.01.013","article-title":"Pregnancy and orthotopic liver transplantation","volume":"45","year":"2013","journal-title":"Transplant Proc"},{"key":"lt25034-bib-0025-20240115","doi-asserted-by":"crossref","first-page":"261","DOI":"10.3109\/14767058.2016.1173671","article-title":"Pregnancy outcomes in liver transplant patients, a population\u2010based study","volume":"30","year":"2017","journal-title":"J Matern Fetal Neonatal Med"},{"key":"lt25034-bib-0026-20240115","doi-asserted-by":"crossref","first-page":"e89151","DOI":"10.1371\/journal.pone.0089151","article-title":"Pregnancy outcomes in liver and cardiothoracic transplant recipients: a UK national cohort study","volume":"9","year":"2014","journal-title":"PloS One"},{"key":"lt25034-bib-0027-20240115","doi-asserted-by":"crossref","first-page":"1153","DOI":"10.1002\/lt.24182","article-title":"Outcomes of pregnancy following liver transplantation: the King's College Hospital experience","volume":"21","year":"2015","journal-title":"Liver Transpl"},{"key":"lt25034-bib-0028-20240115","doi-asserted-by":"crossref","first-page":"1138","DOI":"10.1002\/lt.20810","article-title":"Pregnancy outcome after liver transplantation: a single\u2010center experience of 71 pregnancies in 45 recipients","volume":"12","year":"2006","journal-title":"Liver Transpl"},{"key":"lt25034-bib-0029-20240115","doi-asserted-by":"crossref","first-page":"290","DOI":"10.2215\/CJN.06170612","article-title":"Pregnancy in renal transplant recipients: a UK national cohort study","volume":"8","year":"2013","journal-title":"Clin J Am Soc Nephrol"},{"key":"lt25034-bib-0030-20240115","doi-asserted-by":"crossref","first-page":"1301","DOI":"10.1097\/01.tp.0000263357.44975.d0","article-title":"Pregnancy after organ transplantation: a report from the UK transplant pregnancy registry","volume":"83","year":"2007","journal-title":"Transplantation"},{"key":"lt25034-bib-0031-20240115","doi-asserted-by":"crossref","first-page":"1964","DOI":"10.2215\/CJN.09250914","article-title":"A systematic review and meta\u2010analysis of outcomes of pregnancy in CKD and CKD outcomes in pregnancy","volume":"10","year":"2015","journal-title":"Clin J Am Soc Nephrol"},{"key":"lt25034-bib-0032-20240115","doi-asserted-by":"crossref","first-page":"2011","DOI":"10.1681\/ASN.2014050459","article-title":"Risk of adverse pregnancy outcomes in women with CKD","volume":"26","year":"2015","journal-title":"J Am Soc Nephrol"},{"key":"lt25034-bib-0033-20240115","doi-asserted-by":"crossref","first-page":"766","DOI":"10.1111\/aogs.12648","article-title":"Preterm birth and social inequality: assessing the effects of material and psychosocial disadvantage in a UK birth cohort","volume":"94","year":"2015","journal-title":"Acta Obstet Gynecol Scand"},{"key":"lt25034-bib-0034-20240115","doi-asserted-by":"crossref","first-page":"g2301","DOI":"10.1136\/bmj.g2301","article-title":"Chronic hypertension and pregnancy outcomes: systematic review and meta\u2010analysis","volume":"348","year":"2014","journal-title":"BMJ"},{"key":"lt25034-bib-0035-20240115","first-page":"j895","article-title":"Risk of serious infections associated with use of immunosuppressive agents in pregnant women with autoimmune inflammatory conditions: cohort study","volume":"356","year":"2017","journal-title":"BMJ"},{"key":"lt25034-bib-0036-20240115","doi-asserted-by":"crossref","first-page":"956","DOI":"10.1136\/ard.2010.144741","article-title":"The influence of systemic glucocorticoid therapy upon the risk of non\u2010serious infection in older patients with rheumatoid arthritis: a nested case\u2013control study","volume":"70","year":"2011","journal-title":"Ann Rheum Dis"}],"container-title":["Liver Transplantation"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1002%2Flt.25034","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.lww.com\/01445473-201805000-00007","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,1,15]],"date-time":"2024-01-15T01:14:54Z","timestamp":1705281294000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.lww.com\/01445473-201805000-00007"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,4,10]]},"references-count":34,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2018]]}},"URL":"https:\/\/doi.org\/10.1002\/lt.25034","relation":{},"ISSN":["1527-6465","1527-6473"],"issn-type":[{"value":"1527-6465","type":"print"},{"value":"1527-6473","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,4,10]]}}}