Pregnancy after liver transplant tied to complications, higher healthcare cost

Pregnancy following liver transplant may lead to complications and worse outcomes, but not to an increased risk of mortality, reveals a study.

The investigators performed a retrospective nationwide review comparing pregnancy outcomes in liver transplant recipients relative to the general population between 2005 and 2013. They performed propensity-matched and multivariate regression analyses to assess pregnancy- and delivery-related complications in addition to patient and hospital outcomes.

A total of 38,449,030 pregnancy-related admissions were assessed, including 1,469 (0.004 percent) in liver transplant recipients. These recipients had a higher likelihood of undergoing a caesarean delivery (60 percent vs 36 percent) and of experiencing a pregnancy-related complication (56 percent vs 27 percent), including miscarriage, intrauterine growth restriction, postpartum haemorrhage, hypertension, pre-eclampsia, and thromboembolism (p<0.001) compared with the general population.

In propensity-weighted analysis, transplant recipients also had higher rates of pregnancy complications (odds ratio, 2.11, 95 percent confidence interval [CI], 1.63–2.73), cost ($3,023, 95 percent CI, 850–5,197), and longer length of stay (1.52 days, 95 percent CI, 0.62–2.41). On the other hand, transplant recipients had zero inpatient deaths as opposed to 0.01 percent of the general population.

In addition, transplant recipients with at least one complication had a longer length of stay (2.45 days, 95 percent CI, 1.44–3.45) and higher cost of admission ($5,205, 95 percent CI, 2,848–7,561) relative to those without a complication.

“Given the increased rates of pregnancy in liver transplant recipients, evaluating the safety of pregnancy is crucial,” the investigators said.