Minireviews
Copyright ©2013 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Nov 21, 2013; 19(43): 7647-7651
Published online Nov 21, 2013. doi: 10.3748/wjg.v19.i43.7647
Liver diseases in pregnancy: Liver transplantation in pregnancy
Ghassan M Hammoud, Ashraf A Almashhrawi, Khulood T Ahmed, Rubayat Rahman, Jamal A Ibdah
Ghassan M Hammoud, Ashraf A Almashhrawi, Khulood T Ahmed, Rubayat Rahman, Jamal A Ibdah, Division of Gastroenterology and Hepatology, University of Missouri, Columbia, MO 65212, United States
Author contributions: Hammoud GM wrote and revised the manuscript; Almashhrawi AA, Ahmed KT and Rahman R were involved in reviewing the literature and collecting data; Ibdah JA provided the overall conceptual design and finalized the manuscript.
Correspondence to: Jamal A Ibdah, MD, PhD, Professor, Director, Division of Gastroenterology and Hepatology, University of Missouri, 319 jesse hall, Columbia, MO 65212, United States. ibdahj@health.missouri.edu
Telephone: +1-573-8827349 Fax: +1-573-8844595
Received: June 17, 2013
Revised: July 30, 2013
Accepted: August 16, 2013
Published online: November 21, 2013
Processing time: 183 Days and 19.7 Hours
Abstract

Pregnancy in patients with advanced liver disease is uncommon as most women with decompensated cirrhosis are infertile and have high rate of anovulation. However, if gestation ensued; it is very challenging and carries high risks for both the mother and the baby such as higher rates of spontaneous abortion, prematurity, pulmonary hypertension, splenic artery aneurysm rupture, postpartum hemorrhage, and a potential for life-threatening variceal hemorrhage and hepatic decompensation. In contrary, with orthotopic liver transplantation, menstruation resumes and most women of childbearing age are able to conceive, give birth and lead a better quality of life. Women with orthotopic liver transplantation seeking pregnancy should be managed carefully by a team consultation with transplant hepatologist, maternal-fetal medicine specialist and other specialists. Pregnant liver transplant recipients need to stay on immunosuppression medication to prevent allograft rejection. Furthermore, these medications need to be monitored carefully and continued throughout pregnancy to avoid potential adverse effects to mother and baby. Thus delaying pregnancy 1 to 2 years after transplantation minimizes fetal exposure to high doses of immunosuppressants. Pregnant female liver transplant patients have a high rate of cesarean delivery likely due to the high rate of prematurity in this population. Recent reports suggest that with close monitoring and multidisciplinary team approach, most female liver transplant recipient of childbearing age will lead a successful pregnancy.

Keywords: Liver; Pregnancy; Liver transplantation; Hemolysis elevated liver low platelets; Acute fatty liver; Cirrhosis

Core tip: This review provides an up-to-date summary of literature in the field of liver transplantation and pregnancy. It outlines the outcomes of pregnancy prior to and after orthotopic liver transplantation. Furthermore, it provides input on preconception counseling for mothers contemplating pregnancy after liver transplantation, risks of immunosuppression, and safety of breastfeeding.