A Comparison of the Outcome of Pregnancies After Liver and Kidney Transplantation Cornelia Blume, 1,6 Ayberk Sensoy, 2 Mechthild M. Gross, 3 Heinrich H. Guenter, 3 Hermann Haller, 1,4 Michael P. Manns, 2,4 Anke Schwarz, 1 Frank Lehner, 5 Juergen Klempnauer, 4,5 Sven Pischke, 2,4 and Christian P. Strassburg 2,4 Background. Pregnancies are an issue difficult to manage in recipients of solid organ grafts. Whereas most studies re- port on individual women who have received transplants, we retrospectively studied all gestations of women with liver (LT) or kidney transplants (KT) from October 1988 to August 2010 at one major transplantation center in Germany and compared the outcome. Methods. A total of 115 gestations in 37 women with LT and in 34 women with KT were identified. Mean age and time between transplantation and gestation were comparable in both groups. Results. Whereas 81 (70%) of all gestations were successful, 15 (13%) were terminated, and there were 19 (17%) spontaneous abortions and 2 (2%) intrauterine deaths. The rate of live births in women with LT was higher than that in women with KT (48/62 [77%] vs. 32/53 [62%], P=0.05). Fetal abnormalities were observed in two newborns in women with LT. The duration of successful gestations was lower in women with KT than in women with LT (35 months [range, 26Y41 months] vs. 39 months [range, 26Y40 months], PG0.001). Preterm births occurred in 37% of all women, but predominantly in women with KT associated with a lower birth weight of the newborns. Preeclampsia occurred in 18 women, of whom 14 were women with KT. We observed 10 women with rejection episodes associated to pregnancy; these were 8 women with LT and 2 women with KT. Conclusions. Pregnancies after liver or kidney transplantation had an acceptable outcome with 70% live births. Re- markably, maternal comorbidity and complications during gestation were more frequent in women with KT affecting newborn birth weight. There were more rejections in women with LT than in women with KT. Keywords: Pregnancy, Liver transplantation, Kidney transplantation, Immunosuppression, Outcome. (Transplantation 2013;95: 222Y227) A pregnancy after kidney or liver transplantation represents a management and counseling problem for transplanta- tion physicians and gynecologists. A pregnancy under these conditions is considered as risky because of previous abdominal surgery, concomitant chronic diseases, and the requirement for continued admin- istration of various drugs possibly affecting fetal growth and health. Furthermore, the stability of the graft is the major survival factor for the mother. A well-considered patient management and careful monitoring of the fetus are needed, but distinct recommendations are lacking because of few re- ference cohorts. In this retrospective study of all gestations re- corded at our center for a period of 22 years, we focused on the outcome of mother and child and aimed to find impor- tant clues for clinical decision making in this sensitive field. Since the first pregnancy in a kidney transplant (KT) recipient, described in 1958 (1), and the first pregnancy in a liver transplant recipient in 1978 (2), experience with CLINICAL AND TRANSLATIONAL RESEARCH 222 www.transplantjournal.com Transplantation & Volume 95, Number 1, January 15, 2013 This work was supported by a grant from the German Federal Ministry of Education and Research (IFB-TX; Reference No. 01EO0802). C.B. and A.Se. contributed equally and are considered first authors. S.P. and C.P.S. contributed equally and are considered senior authors. This work represents the thesis of Ayberk Sensoy, M.D. The authors declare no conflicts of interest. 1 Department of Nephrology and Hypertensiology, Hannover Medical School, Hannover, Germany. 2 Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany. 3 Department of Obstetrics, Gynecology Hannover Medical School, Han- nover, Germany. 4 Department of Transplantation Surgery, Hannover Medical School, IFB- TX, Hannover, Hannover, Germany. 5 Surgery, Hannover Medical School, Hannover, Germany. 6 Address correspondence to: Cornelia Blume, Department of Nephrology and Hypertensiology, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625 Hannover, Germany. E-mail: blume.cornelia@mh-hannover.de C.B., A.Se., S.P., and C.P.S. participated in research design, in writing the article, and in data analysis. M.M.G. participated in research design and in writing the article. H.H.G., H.H., M.P.M., A.Sc., F.L., and J.K. par- ticipated in research design. Supplemental digital content (SDC) is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal’s Web site (www.transplantjournal.com). Received 6 August 2012. Revision requested 28 August 2012. Accepted 5 October 2012. Copyright * 2013 by Lippincott Williams & Wilkins ISSN: 0041-1337/13/9501-222 DOI: 10.1097/TP.0b013e318277e318 Copyright © 2012 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.