{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T04:00:17Z","timestamp":1788494417219,"version":"build-2803163510"},"reference-count":18,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"6","license":[{"start":{"date-parts":[[2018,6,1]],"date-time":"2018-06-01T00:00:00Z","timestamp":1527811200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"},{"start":{"date-parts":[[2018,6,6]],"date-time":"2018-06-06T00:00:00Z","timestamp":1528243200000},"content-version":"vor","delay-in-days":5,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Liver Transpl"],"published-print":{"date-parts":[[2018,6]]},"abstract":"<jats:p>Due to advances in obstetric and transplant medicine, women with a history of liver transplantation can have successful pregnancies. However, data on pregnancy outcomes is still limited, especially for women who have had a repeat liver transplant following graft rejection. This retrospective study compares pregnancy outcomes in women with single and repeat liver transplants managed at 2 tertiary hospitals in Toronto, Canada and Leuven, Belgium. We identified 41 pregnancies in 28 transplanted women, 6 of whom conceived following a second liver transplant after the first was rejected. Mean maternal age at delivery was 30 \u00b1 7 years, and transplant\u2010to\u2010pregnancy interval was 8.5 \u00b1 5.1 years. All women had normal liver function upon conception. Immunosuppressants included tacrolimus \u00b1 azathioprine (n = 26), cyclosporine (n = 4), and prednisone with immunosuppressants (n = 11). There were no maternal deaths. Maternal complications included hypertensive disorders of pregnancy (n = 10), deterioration in renal function (n = 6), gestational diabetes (n = 4), graft deterioration (n = 2), and anemia requiring blood transfusion (n = 1). Fetal\/neonatal adverse outcomes included 2 miscarriages, 3 stillbirths, 1 neonatal death, 5 small\u2010for\u2010gestational\u2010age infants, and 1 minor congenital anomaly. Mean gestational age at delivery was 36.7 \u00b1 4.2 weeks. There were 14 (38.9%) preterm births. Outcomes in women with a second transplant were similar to those with a single transplant, except for a higher incidence of hypertensive disorders. In conclusion, with appropriate multidisciplinary care, stable graft function at pregnancy onset, and adherence to immunosuppressive regimens, women with single and repeat liver transplants have low rates of graft complications but remain at increased risk for pregnancy complications. Immunosuppressants and high\u2010dose glucocorticoids can be safely used for maintenance of graft function and management of graft deterioration in pregnancy. <jats:italic toggle=\"yes\">Liver Transplantation 24 769\u2013778 2018<\/jats:italic> AASLD.<\/jats:p>","DOI":"10.1002\/lt.25071","type":"journal-article","created":{"date-parts":[[2018,4,14]],"date-time":"2018-04-14T23:05:07Z","timestamp":1523747107000},"page":"769-778","source":"Crossref","is-referenced-by-count":21,"title":["Pregnancy outcomes following single and repeat liver transplantation: An international 2\u2010center cohort"],"prefix":"10.1097","volume":"24","author":[{"given":"Nusrat","family":"Zaffar","sequence":"first","affiliation":[{"name":"Division of Maternal and Fetal Medicine, Department of Obstetrics & Gynaecology, Mount Sinai Hospital,University of Toronto,Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elisabeth","family":"Soete","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology,University Hospital Leuven,Leuven,Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shital","family":"Gandhi","sequence":"additional","affiliation":[{"name":"Division of Obstetric Medicine, Department of Internal Medicine, Mount Sinai Hospital,University of Toronto,Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Parastoo","family":"Sayyar","sequence":"additional","affiliation":[{"name":"Division of Maternal and Fetal Medicine, Department of Obstetrics & Gynaecology, Mount Sinai Hospital,University of Toronto,Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tim","family":"Van Mieghem","sequence":"additional","affiliation":[{"name":"Division of Maternal and Fetal Medicine, Department of Obstetrics & Gynaecology, Mount Sinai Hospital,University of Toronto,Canada"},{"name":"Department of Obstetrics and Gynecology,University Hospital Leuven,Leuven,Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4049-2017","authenticated-orcid":false,"given":"Rohan","family":"D'Souza","sequence":"additional","affiliation":[{"name":"Division of Maternal and Fetal Medicine, Department of Obstetrics & Gynaecology, Mount Sinai Hospital,University of Toronto,Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2018,6,6]]},"reference":[{"key":"lt25071-bib-0002-20240115","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 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