Pregnancy outcomes and management in lung and heart transplant recipients: a systematic review
File(s)
Published version
Author(s)
Type
Journal Article
Abstract
Immunosuppression advances have enabled organ transplant recipients to consider parenthood, but pregnancy poses risks to maternal and fetal health. This systematic review examines pregnancy outcomes and immunosuppression management in cardiothoracic transplant recipients. We conducted a literature search of PubMed/Medline, Embase, and Maternity & Infant Care Database in December 2022. We identified 54 relevant studies and data from the Transplant Pregnancy Registry International (TPRI), covering 404 pregnancies from 272 heart recipients (HTR) and 148 pregnancies from 121 lung recipients (LTR). Live births occurred in 74.3% of HTR and 65.5% of LTR pregnancies (22% preterm). Graft dysfunction developed in 11.5% (during) and 12.4% (after) of HTR pregnancies, and 17.6% (during) and 18% (after) of LTR pregnancies. Other complications included hypertension (HTR: 36.9%, LTR: 58.8%), preeclampsia (HTR: 19.7%, LTR: 12.2%), and diabetes (HTR: 11%, LTR: 27%). Mortality was 17.4% for HTR and 26.5% for LTR. Half of HTR and two-thirds of LTR were on Tacrolimus. Common immunosuppression changes included discontinuation of Mycophenolate Mofetil (MMF), Azathioprine, or Sirolimus with corticosteroid dose adjustment. Despite high successful pregnancy rates, HLTR may face substantial risks of graft dysfunction and maternal death post-pregnancy. (182 words)
Date Issued
2025-08-01
Date Acceptance
2025-05-19
Citation
JHLT Open, 2025, 9
ISSN
2950-1334
Publisher
Elsevier
Journal / Book Title
JHLT Open
Volume
9
Copyright Statement
© 2025 The Authors. Published by Elsevier Inc. on behalf of International Society for Heart and Lung Transplantation. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
License URL
Identifier
10.1016/j.jhlto.2025.100297
Subjects
Lung transplantation
Heart transplantation
Pregnancy
Immunosuppression
HLTR AST, American Society of Transplantation
BOS, Bronchiolitis Obliterans Syndrome
CDC, Centers for Disease Control
CLAD, Chronic Lung Allograft Dysfunction
CNI, Calcineurin Inhibitor
CR, Case Report
CS, Case Series
CsA, Cyclosporine A
ERA-EDTA, European Renal Association-European Dialysis and Transplant Association
FDA, United States Food and Drug Agency
FEV1, Forced Expiratory Volume in the 1st second
HLTR, Heart and Lung Transplant Recipients
HTR, Heart Transplant Recipients
IMPDH, Inosine Monophosphate Dehydrogenase
ISHLT, International Society for Heart and Lung Transplantation
IUD, Intrauterine Device
IUGR, Intrauterine Growth Restriction
LTR, Lung Transplant Recipients
LVEF, Left Ventricle Ejection Fraction
MMF, Mycophenolate Mofetil
MPA, Mycophenolic Acid
NTPR, American National Transplantation in Pregnancy Registry
RCS, Retrospective Cohort Studies
SGA, Small-for-Gestational Age
TPRI, Transplant Pregnancy Registry International
UKTPR, UK Transplant Pregnancy Registry ]] ]] ]]]]]]
Publication Status
Published
Article Number
100297
Date Publish Online
2025-05-27