Pregnancy after liver transplantation (Literature review)

Liver transplantation is a radical treatment for end-stage liver disease. Improved transplantation outcomes have led to an increasing number of women of reproductive age with functioning grafts, making pregnancy after liver transplantation an important clinical issue. Pregnancy following liver transplantation is associated with increased risks for both mother and fetus, including complications related to immunosuppressive therapy, graft dysfunction, and comorbidities.

Objective. To analyze pregnancy cases in women after liver transplantation, evaluate current research and international guidelines for patients of reproductive age following liver transplantation, and identify risk factors affecting pregnancy outcomes and maternal-fetal health.

Materials and methods. A literature search was conducted in PubMed, Scopus, Web of Science, eLibrary.ru, and Google Scholar databases for the period 2014-2025 using keywords: liver transplantation, pregnancy, pregnancy outcome, immunosuppressive therapy, rejection, preeclampsia. Inclusion criteria were original studies, systematic reviews, meta-analyses, clinical cases, and professional society guidelines. Exclusion criteria included publications without full-text access and duplicate data. A total of 36 sources were analyzed.

Results and discussion. According to literature data, live birth rates after liver transplantation range from seventy to eighty percent, however rates of preterm delivery (thirty to forty percent), preeclampsia (twelve to fifteen percent), and cesarean section (forty to fifty percent) significantly exceed those in the general population. Risk of graft rejection during pregnancy is three to ten percent. Major maternal complications include gestational hypertension, preeclampsia, gestational diabetes, and infectious complications. Most common fetal complications are intrauterine growth restriction, prematurity, and low birth weight. International guidelines emphasize the need for pregnancy planning no earlier than one to two years post-transplantation with stable graft function and absence of rejection episodes, as well as adjustment of immunosuppressive therapy to pregnancy-safe medications. Primary drugs of choice are tacrolimus and cyclosporine, while mycophenolate mofetil should be replaced with azathioprine at least six weeks before planned conception. Pregnancy management requires careful multidisciplinary monitoring involving a transplant surgeon, high-risk obstetrician, and neonatologist.

Conclusion. Pregnancy after liver transplantation is a complex process requiring a multidisciplinary approach and careful monitoring. Despite improved prognosis, pregnancy in these cases carries increased risks. Further research is needed to optimize pregnancy management, develop strategies to reduce graft rejection risk, and minimize complications.

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